State Fair Hearing Process Sample Clauses

State Fair Hearing Process. In accordance with 42 CFR 438.408, the State maintains a fair hearing process which allows members the opportunity to appeal the Contractor’s decisions to the State. Appeal procedures for applicants and recipients of Medicaid are found at 405 IAC 1.1. The State fair hearing procedures include the requirements described in this Section 4.9.5. Members shall first exhaust the Contractor’s grievance and appeals process. The member may request an FSSA fair hearing within sixty (60) calendar days from the date of the Contractor’s decision. The parties to the FSSA fair hearing shall include the Contractor, as well as the member and his or her representative or the representative of a deceased member's estate. The Contractor shall respond to all requests for documentation required for the FSSA fair hearing within the timeframe identified in the request. In addition, if requested by OMPP at least five (5) business days in advance, the Contractor shall send a representative to the FSSA fair hearing to represent the State. Contractor will be subject to the contract compliance remedies set forth in Exhibit 2 for failing to either (i) provide a timely and satisfactory response to documentation required for an appeal or (ii) to represent the State at the FSSA fair hearing upon adequate notice. Adequate notice, at a minimum, requires notice of hearing mailed by the Office of Hearings and Appeal, or in the alternative, a request sent directly to the Compliance Officer by the Office of Medicaid Policy and Planning. If dissatisfied with the outcome of the State fair hearing, the member may request an agency review within ten (10) days of receipt of the administrative law judge’s decision. Pursuant to 405 IAC 1.1-3-1, if the member is not satisfied with the final action after agency review, the member may file a petition for judicial review in accordance with IC 4- 21.5-5. The MCE may request an agency review of a decision made by an administrative law judge, at the Contractor's discretion. The Contractor shall include the FSSA fair hearing process as part of the written internal process for resolution of appeals and shall describe the fair hearing process in the member handbook.
Sample 1Sample 2Sample 3See All (8)
AutoNDA by SimpleDocs
State Fair Hearing Process. The Contractor shall educate its enrollees of their right to appeal directly to the Division. The enrollee has the right to appeal to the Division at the same time that he appeals to the Contractor; after he has exhausted his appeal rights with the Contractor; or instead of appealing to the Contractor. Any adverse action or appeal that is not resolved wholly in favor of the enrollee by the Contractor may be appealed by the enrollee or the enrollee’s authorized representative to the Division for a fair hearing conducted in accordance with 42 CFR § 431 Subpart E. Adverse actions include reductions in service, suspensions, terminations, and denials. Furthermore, the Contractor’s denial of payment for Mississippi Medicaid covered services and failure to act on a request for services within required timeframes may also be appealed. Appeals must be requested in writing by the enrollee or the enrollee’s representative within thirty (30) days of the enrollee’s receipt of notice of adverse action unless an acceptable reason for delay exists. An acceptable reason shall include, but not be limited to, situations or events where: • Appellant was seriously ill and was prevented from contacting the Contractor. • Appellant did not receive notice of the Contractor’s decision. • Appellant sent the request for appeal to another government agency in good faith within the time limit; • Unusual or unavoidable circumstances prevented a timely filing. Additionally, if the Contractor’s notice is “defective,” i.e., does not contain the required elements, cause may exist. The Division reserves the right to sanction the Contractor per occurrence whenever it is identified that the Contractor has failed to provide notice or provides an incorrect notice of appeal rights. For enrollee appeals, the Contractor is responsible for providing to the Division and to the enrollee an appeal summary describing the basis for the denial. For standard appeals, the appeal summary must be submitted to the Division and the enrollee at least ten (10) calendar days prior to the date of the hearing. For expedited appeals, (that meet the criteria set forth in 42 CFR § 438.410) the appeal summary must be faxed to the Division and faxed or overnight mailed to the enrollee, as expeditiously as the enrollee’s health condition requires, but no later than four (4) business hours after the Division informs the Contractor of the expedited appeal. The Division may require that the CCO attend the hearing either via ...
Sample 1Sample 2Sample 3See All (6)
State Fair Hearing Process. In accordance with 42 CFR 438.408, the State maintains a fair hearing process which allows members the opportunity to appeal the Contractor’s decisions to the State. Refer to 405 IAC 1.1 for the appeal procedures for applicants and recipients of Medicaid. Members must first exhaust the Contractor’s grievance and appeals process. Within sixty (60) calendar days of exhausting the Contractor’s internal procedures, the member may request a FSSA fair hearing. The parties to the FSSA fair hearing shall include the Contractor, as well as the member and his or her representative or the representative of a deceased member's estate. If dissatisfied with the outcome of the FSSA fair hearing, the member may request an agency review within ten (10) days of the administrative law judge’s decision. An agency decision may be brought before a judicial review pursuant to 405 IAC 1.1-3-1. The Contractor must include the FSSA fair hearing process as part of the written internal process for resolution of appeals and must describe the fair hearing process in the member handbook described in Section 4.4.2.
Sample 1Sample 2Sample 3See All (6)
State Fair Hearing Process. In accordance with 42 CFR 438.408, the State maintains a fair hearing process which allows members the opportunity to appeal the Contractor’s decisions to the State. Refer to 405 IAC 1.1 for the appeal procedures for applicants and recipients of Medicaid. Members must first exhaust the Contractor’s grievance and appeals process. The Contractor must timely coordinate the grievance and appeal process. Within one hundred and twenty (120) calendar days of exhausting the Contractor’s internal procedures, the member may request a FSSA fair hearing. The parties to the FSSA fair hearing shall include the Contractor, as well as the member and his or her representative or the representative of a deceased member's estate. If dissatisfied with the outcome of the FSSA fair hearing, the member may request an agency review within ten (10) days of the administrative law judge’s decision. An agency decision may be brought before a judicial review pursuant to 405 IAC 1.1-3-1. The Contractor will be subject to the contract compliance remedies (set forth in Exhibit 2 Contract Compliance and Pay for Outcomes) for failing to provide a timely and satisfactory response to documentation required for an appeal or failure to represent the state at the FSSA fair hearing.
Sample 1Sample 2Sample 3See All (4)
State Fair Hearing Process. In accordance with 42 CFR 438.408, the State maintains a fair hearing process which allows members the opportunity to appeal the Contractor’s decisions to the State. Refer to 405 IAC
Sample 1Sample 2Sample 3
State Fair Hearing Process. 5. The FEA is required to provide the DHS and/or the participant’s ICA with any documentation requested for the Wisconsin State Fair Hearing process. This requirement is applicable both when the ICA issues the NOA on behalf of DHS or when the NOA is issued from DHS as a result of a budget amendment, one-time expense request, or other termination, denial, limitation, or reduction of service.
Sample 1
State Fair Hearing Process. In accordance with 42 CFR 438.408, the State maintains a fair hearing process which allows members the opportunity to appeal the Contractor’s decisions to the State. Refer to 405 IAC 1.1 for the appeal procedures for applicants and recipients of Medicaid. Members must first exhaust the Contractor’s grievance and appeals process. Within one hundred and twenty (120) calendar days of exhausting the Contractor’s internal procedures, the member may request a FSSA fair hearing. The parties to the FSSA fair hearing shall include the Contractor, as well as the member and his or her representative or the representative of a deceased member's estate. If dissatisfied with the outcome of the FSSA fair hearing, the member may request an agency review within ten (10) days of the administrative law judge’s decision. An agency decision may be brought before a judicial review pursuant to 405 IAC 1.1-3-1.
Sample 1
AutoNDA by SimpleDocs
State Fair Hearing Process. At any time during the grievance process, per California State law, you may also request a fair hearing from the California Department of Social Services by contacting or writing to: California Department of Social Services State Hearings Division P.O. Box 944243, Mail Station 19-37 Sacramento, CA 00000-0000 Telephone: 0-000-000-0000 Fax: 000-000-0000 TDD: 0-000-000-0000 If you want a State fair hearing, you must ask for it within ninety (90) days from the date of receiving the letter for the resolved grievance. You or your representative may speak at the State hearing or have someone else speak on your behalf, including a relative, friend or an attorney. You may also be able to get free legal help. We will provide you or your representative a list of Legal Services in the county where you live at the time you file a grievance.
Sample 1
State Fair Hearing Process. In accordance with 42 CFR 438.408, the State maintains a fair hearing process which the State. Appeal procedures for applicants and recipients of Medicaid are found at 405 IAC 1.1. The State fair hearing procedures include the requirements described in this Section 4.9.5.
Sample 1

Related to State Fair Hearing Process

  • Hiring Process i. School District and Teach For America will collaborate in good faith to facilitate the efficient hiring of individual Teachers, in accordance with the School District’s established District hiring practices.

  • Bidding Process 3.1. Bidding shall generally commence based on the sequence of the lot being shown on the PAH Website. However the Auctioneer has the right to vary the sequence without having to give prior notice to the intended bidders.

  • PROFESSIONAL DEVELOPMENT AND EDUCATIONAL IMPROVEMENT A. The Board agrees to implement the following:

  • CHILD AND DEPENDENT ADULT/ELDER ABUSE REPORTING CONTRACTOR shall establish a procedure acceptable to ADMINISTRATOR to ensure that all employees, agents, subcontractors, and all other individuals performing services under this Agreement report child abuse or neglect to one of the agencies specified in Penal Code Section 11165.9 and dependent adult or elder abuse as defined in Section 15610.07 of the WIC to one of the agencies specified in WIC Section 15630. CONTRACTOR shall require such employees, agents, subcontractors, and all other individuals performing services under this Agreement to sign a statement acknowledging the child abuse reporting requirements set forth in Sections 11166 and 11166.05 of the Penal Code and the dependent adult and elder abuse reporting requirements, as set forth in Section 15630 of the WIC, and shall comply with the provisions of these code sections, as they now exist or as they may hereafter be amended.

  • State Approval of Replacement Personnel The Engineer may not replace the project manager or key personnel without prior consent of the State. The State must be satisfied that the new project manager or other key personnel is qualified to provide the authorized services. If the State determines that the new project manager or key personnel is not acceptable, the Engineer may not use that person in that capacity and shall replace him or her with one satisfactory to the State within forty-five (45) days.

  • Ordering Process 6.4.1 CLEC, or CLEC's agent, shall act as the single point of contact for its End User Customers' service needs, including without limitation, sales, service design, order taking, Provisioning, change orders, training, maintenance, trouble reports, repair, post-sale servicing, Billing, collection and inquiry. CLEC's End User Customers contacting Qwest in error will be instructed to contact CLEC; and Qwest's End User Customers contacting CLEC in error will be instructed to contact Qwest. In responding to calls, neither Party shall make disparaging remarks about each other. To the extent the correct provider can be determined, misdirected calls received by either Party will be referred to the proper provider of local Exchange Service; however, nothing in this Agreement shall be deemed to prohibit Qwest or CLEC from discussing its products and services with CLEC's or Qwest's End User Customers who call the other Party seeking such information.

  • New Application for Licensure Any time after the three-month period has lapsed from the Effective Date of this Agreement and Respondent has paid the Administrative Penalty set forth in Section III, Paragraph 1 of this Order, Respondent may apply for a new mortgage loan originator license or, as applicable, petition for the reinstatement of an MLO Activity Endorsement in any or all of the Participating States with the understanding that each State Mortgage Regulator reserves the rights to fully investigate such application for licensure or petition for reinstatement of an MLO Activity Endorsement and may either approve or deny such application or petition pursuant to the normal process for such licensing or endorsement investigations. No license application or petition described in this paragraph will be denied solely based on the facts, circumstances, or consensual resolution provided for in this Agreement. Respondent further agrees that Respondent must satisfy the Administrative Penalty provision prior to submitting an application for a new mortgage loan originator license or, as applicable, petition for the reinstatement of an MLO Activity Endorsement.

Time is Money Join Law Insider Premium to draft better contracts faster.