Continuation of Benefits Pending an Appeal. The ICDS Plan must provide continuing benefits for all previously approved non-Part D benefits that are being terminated or modified pending the ICDS Plan’s internal Appeal process, subject to the requirements as indicated in 2.10.3.4.4. This means that such benefits, when requested by the beneficiary, will continue to be provided by Providers to Beneficiaries and that the ICDS Plans must continue to pay Providers for providing such previously authorized services or benefits pending an internal Appeal.
Continuation of Benefits Pending an Appeal. The Contractor must provide continuing benefits for all previously approved non-Part D benefits that are being terminated or modified pending the Contractor’s internal Appeal process. This means that such benefits will continue to be provided by Providers to Enrollees and that the Contractors must continue to pay Providers for providing such services or benefits pending an internal Appeal.
Continuation of Benefits Pending an Appeal. The Contractor must provide continuing benefits for all previously approved non-Part D benefits that are being terminated or modified pending the Contractor’s internal Appeal process. If the Contractor does not decide fully in the Enrollee’s favor within the relevant timeframe, the Contractor must continue providing benefits for all previously approved non-Part D benefits that are being terminated or modified through the IRE review. If the resolution of the IRE is not wholly in favor of the Enrollee, services will be required to be provided and paid for pending resolution of the State Fair Hearing Appeal process, if the Enrollee files an Appeal with the State Fair Hearing Agency within ten (10) calendar days of the notice of disposition from the IRE.
Continuation of Benefits Pending an Appeal. If an Enrollee files an Appeal within ten (10) calendar days after the date of a notice of Adverse Action from the Contractor and the Enrollee requests that the disputed Covered Services be continued pending the Appeal, then the Contractor must continue the Enrollee’s benefits during the Appeal process. This includes continuing benefits in a case where the authorization for such disputed Covered Services expires or authorization limits for such Covered Services are met. Pursuant to 42 C.F.R. § 438.420, if the final resolution of the Appeal is adverse to the Enrollee, the Contractor may recover the cost of the services that were furnished to the Enrollee. If the Contractor or the State Fair Hearing Officer reverses a decision to deny, limit or delay Covered Services, and those services were not furnished while the Appeal was pending, the Contractor must authorize or provide the disputed services as expeditiously as the Enrollee’s health condition requires. If the Contractor or the State Hearing Officer reverses a decision to deny authorization of Covered Services, and the Enrollee received the disputed services while the Appeal was pending, the Contractor must pay for those services in accordance with State rules and policy.
Continuation of Benefits Pending an Appeal. 1. All Medicare Parts A and B, and non-Part D benefits will be required to be provided pending the resolution of the Demonstration Plan Appeal process. This means that such benefits will continue to be provided by providers to Enrollees, and that Demonstration Plans must continue to pay providers for providing such services pending the resolution of the Demonstration Plan Appeal process.
Continuation of Benefits Pending an Appeal. 2.15.5.1. Medicare Benefits and Services
Continuation of Benefits Pending an Appeal. Pursuant to procedures and requirements documented in OAC rule 5160-58-08.4, the ICDS Plan must provide continuing benefits, when requested by the beneficiary, for all previously authorized non-Part D benefits that are being terminated or modified pending the ICDS Plan’s internal Appeal process. If the ICDS Plan does not decide fully in the Beneficiary’s favor within the relevant timeframe, the ICDS Plan must continue providing benefits for any previously authorized non-Part D benefits that are being terminated or modified through the period of IRE review or State Hearing decision period. This means that benefits previously authorized by the ICDS Plan and for which the authorization period has not expired and for which the Beneficiary requests continuation, will continue to be provided by Providers to Beneficiaries, and that the ICDS Plan must continue to pay Providers for providing services pending an internal ICDS Plan Appeal or state hearing request or IRE review. Payments will not be recouped based on the outcome of the Appeal for services covered during pending Appeals.
