MOAHR definition
Examples of MOAHR in a sentence
An impartial review of a decision made by the MDHHS or one of its contract agencies which is conducted by a Michigan Office of Administrative Hearings and Rules (MOAHR) Administrative Law Judge under the oversight, supervision, and authority of MDHHS so as to provide due process rights required by applicable law and consistent with 42 C.F.R. §431 subpart E.
Appeals related to drugs excluded from Part D that are covered by Medicaid must be filed with the entity and/or MOAHR.
Adverse internal Appeals will be auto-forwarded to the IRE by the entity, and the Enrollee may also file a request for a hearing with MOAHR in accordance with Section 2.11.2.7.3. If an Appeal is sent to the IRE and filed with MOAHR, any determination in favor of the Enrollee will bind the entity and will require payment by the entity for the service or item in question granted in the Enrollee’s favor which is closest to the Enrollee’s relief requested on Appeal.
Internal Appeals for Medicaid service denials must be made to the entity taking the action prior to filing an Appeal with MOAHR.
Appeals to MOAHR will not be automatically forwarded by the entity.
Both parties understand that at any time this MOU may be terminated by written notification from either party to the other.
The Medicaid State Fair Hearing Process If the entity’s internal Appeal decision is not fully in the Enrollee’s favor, or if the entity fails to adhere to Notice and timing requirements the Enrollee may Appeal to MOAHR for Medicaid-based adverse decisions.
Sustained decisions by the entity resulting in Medicaid service denials will not be auto-forwarded to MOAHR but may be Appealed by Enrollees or their authorized representative to MOAHR within one hundred and twenty (120) days of the Notice of resolution.