State fair definition
Examples of State fair in a sentence
Each Member State shall accord to covered investments of investors of any other Member State, fair and equitable treatment and full protection and security.
The Contractor’s appeal decision notice must describe the actions taken, the reasons for the action, the member’s right to request a State fair hearing, process for filing a fair hearing and other information set forth in 42 CFR 438.408(e).
Procedures The Contractor shall provide specific information regarding member grievance, appeal and State fair hearing procedures and timeframes to members, as well as providers and subcontractors at the time they enter a contract with the Contractor.
In accordance with 42 CFR 438.424, if the Contractor or State fair hearing officer reverses a decision to deny, limit, or delay services that were not furnished while the appeal was pending, the Contractor shall authorize or provide the disputed services promptly, and as expeditiously as the member’s health condition requires.
If the Contractor or the State fair hearing officer reverses a decision to deny authorization of services, and the member received the disputed services while the appeal was pending, the Contractor shall pay for those services.
If the Contractor fails to adhere to these notice and timing requirements, the beneficiary is deemed to have exhausted the Contractor’s appeals process and may initiate a State fair hearing.
If the Contractor or State fair hearing officer reverses an action to deny, limit, or delay services that were not furnished while the Appeal was pending, the Contractor shall authorize or provide the disputed services promptly and as expeditiously as the Enrollee’s health condition requires, but no later than 72 hours from the date it receives notice reversing the determination.
If the Contractor or the State fair hearing officer reverses a decision to deny authorization of services, and the member received the disputed services while the appeal was pending, the Contractor must pay for those services.
An external review does not inhibit or replace the member’s right to appeal a Contractor decision to a State fair hearing.
A provider may file a grievance or request a State fair hearing on behalf of a beneficiary, if the State permits the provider to act as the enrollee's authorized representative in doing so.