BE YOUR OWN BEST ADVOCATE: A Toolkit for Representing Yourself in Personal Assistance Services (PAS) Appeals

If you had an assessment and your Community HealthChoices (CHC) plan has denied or reduced your Personal Assistance Services (PAS) hours, you should file an appeal to challenge the decision.

This toolkit highlights the most important information to present during your PAS appeal, and shares questions that you and your caregiver(s) should address as you prepare for and present your case during the appeal. There are three stages of appeal:

1. Grievance Hearing: An internal meeting between you and three people from your CHC plan, known as the “grievance committee.” The committee typically has a doctor, an employee of the plan, and a community member.
2. External Review: A paper-based review of your case. An outside medical organization (known as an “external review organization”) will review your plan documents and any additional documents you send to them. Common documents to send include a letter from your doctor, medical records, or a letter you write explaining why you need your PAS hours.
3. Fair Hearing: A hearing about your case before an Administrative Law Judge. A representative from your CHC plan will have an opportunity to present their case and explain why the plan denied your hours. You will then present your case and explain why you need your hours.

How to Use This Toolkit

This toolkit highlights the most important information to present during your PAS appeal, and shares questions that you and your caregiver(s) should address as you prepare for and present your case during the appeal.

The questions and topics in this toolkit are commonly asked by grievance committees and during fair hearings. They will also help you think about information to share for your external review. For instance, you may want to use your answers to write a short letter explaining why you need the PAS hours you are requesting or to write a schedule of your day.
 

GET THE TOOLKIT (PDF)