Continuation of Benefits Pending Appeal. 3.10.1. Continuation of benefits for all prior-approved Medicare and Medicaid benefits that are terminated or modified, pending internal participating plan appeals, second level appeals at OAH, and third level appeals at Medicare Appeals Council must be provided if the original appeal is requested to the participating plan within ten (10) calendar days of the notice’s postmark date (of the decision that is being appealed) or by the intended effective date of the Action, whichever is later.
Continuation of Benefits Pending Appeal. Continuation of benefits for all prior-approved Medicare and Medicaid benefits that are terminated or modified, pending internal FIDA-IDD Plan appeals, Integrated Administrative Hearings Unit, and Medicare Appeals Council must be provided if the original appeal is requested to the FIDA-IDD Plan within 10 calendar days of the notice’s postmark date (of the decision that is being appealed) or by the intended effective date of the Action, whichever is later. For benefits to continue pending appeal at the Medicare Appeals Council, the appeal to the Medicare Appeals Council must be requested within 10 calendar days of the postmark date of the Integrated Administrative Hearings Unit decision.
Continuation of Benefits Pending Appeal i. As provided in 42 CFR §431.211, and §431.230, §420, and §424, continuations of covered Medicaid services will continue to be required when a request is made within the applicable timeframes for making such request. This means that authorized benefits will continue to be provided, and that STAR+PLUS MMPs must continue to pay providers for providing services pending an internal STAR+PLUS MMP appeal or Fair Hearing request. Payments will not be recouped based on the outcome of the appeal for services covered during pending appeals. This right to aid pending an appeal currently exists in Medicaid, but generally is not currently available in Medicare.
Continuation of Benefits Pending Appeal. If the Enrollee files a written request for Appeal with the STATE pursuant to Minnesota Statutes, Section 256.045, Subdivision 3a before the date of the proposed action in either the HEALTH PLAN’s DTR notice or the HEALTH PLAN’s formal Complaint decision, the HEALTH PLAN may not reduce or terminate the service until the STATE issues a written decision on the Appeal. In the case of a reduction or termination of ongoing services under Section 8.2.6., assuming all other requirements of the Section have been met, services must be continued pending outcome of all Internal Complaint Process and Administrative Appeal hearings if: (1) there is an existing order for services by the treating and Participating Provider, or (2) the treating and Participating Provider orders discontinuation of services and another Participating Provider orders the service, but only if that provider is authorized by his/her contract with the HEALTH PLAN to order such services. The notice required by Section 8.2.6. shall include this right.
