State Fair Hearing. See Administrative Law Hearing Subcontract: Any written contract between the Contractor and a third party, including a Provider, to perform a specified part of the Contractor’s obligations under this Contract.
State Fair Hearing. A “state fair hearing” is a quasi-judicial proceeding conducted by a judge, during which each hearing party may present arguments and evidence, including witness(es), and cross examine witness(es) against them, with respect to a decision regarding the availability or delivery of services or benefits, made by an agency. An “agency” is a government unit or managed care health plan involved in a hearing as a hearing party. Such agencies include all 58 California counties, the Los Angeles Department of Children and Family Services, the California Department of Aging, the CDSS Office of Services to the Blind, all 27 Medi- Cal Field Offices, and several CDHS units, including: Beneficiary Utilization Review Unit, Benefits Branch-Vision, In-Home Operations, Managed Care Operations Branch, Recovery Section, and Office of Medi-Cal Dental Services.
State Fair Hearing. An impartial review of a decision made by the MDHHS or one of its contract agencies which is conducted by a Michigan Administrative Hearings System (MAHS) Administrative Law Judge under the oversight, supervision, and authority of MDHHS so as to provide due process rights required by applicable law.
State Fair Hearing. Medicaid consumers who request or receive services that are paid for with Medicaid funds per Michigan’s approved use of Section (a)(1)(A) of the Social Security Act will be provided an Adverse Benefit Determination when services are denied, reduced, suspended or terminated. Consumers must exercise their right to a local appeal process before requesting their right to a State Fair Hearing.
State Fair Hearing. A hearing conducted by the Division or its Agent in accordance with 42 C.F.R. § 431 Subpart E for applicants, Members or beneficiaries.
State Fair Hearing. Providers must exhaust UHC appeal process prior to submitting a State Fair Hearing. • Request must specifically request a “fair hearing” and should describe the decision appealed and the specific reasons for the appeal. • Requests must be submitted within 30 calendar days from the date of the notice of the action, plus 3 calendar days if the notice is mailed. • Send written request via regular mail to: Office of Administrative Hearings 0000 X. Xxxxxx Xxxxxx Xxxxxx, XX 00000 Refer to Chapter 15 of the Provider Administrative Guides found on UHC Community Plan for additional information.
State Fair Hearing. A hearing conducted by the Division of Medicaid or its Agent in accordance with 42 C.F.R. § 431 Subpart E.
State Fair Hearing. An Appeal filed for Medicaid services with the State Board of Hearings. State Medicaid Agency Contract (SMAC) - A set of requirements for all new and existing Medicare Advantage organizations seeking to offer a D-SNP. Surrogate – An Enrollee’s legal guardian, family Member, or other person who has been identified in the Service Agreement with the Personal Care Management (PCM) agency that will be responsible for performing certain personal care attendant (PCA) management tasks that the Enrollee is unable to perform. The Surrogate must live in proximity to the Enrollee and be readily available to perform the PCA management tasks. Total Adjusted Expenditures - The sum of the Adjusted Service Expenditures and the Adjusted Non-Service Expenditures.
State Fair Hearing. The process used by the Wisconsin Division of Hearing and Appeals to adjudicate member appeals of HMO adverse benefit determinations.
