Fair Hearings. 25.1 Enrollee Access To Fair Hearing Process Enrollees may access the fair hearing process in accordance with applicable federal and state laws and regulations. Contractors must abide by and participate in New York State's Fair Hearing Process and comply with determinations made by a fair hearing officer.
25.2 Enrollee Rights to a Fair Hearing Enrollees may request a fair hearing regarding adverse LDSS determinations concerning enrollment, disenrollment and eligibility, and regarding the denial, termination, suspension or reduction of a clinical treatment or other Benefit Package services by the Contractor. For issues related to disputed services, Enrollees must have received an adverse determination from the Contractor or its approved utilization review agent either overriding a recommendation to provide services by a Participating Provider or confirming the decision of a Participating Provider to deny those services. An Enrollee may also seek a fair hearing for a failure by the Contractor to act with reasonable promptness with respect to such services. Reasonable promptness shall mean compliance with the time frames established for review of grievances and utilization review in Sections 44 and 49 of the Public Health Law.
Fair Hearings. Pursuant to 18 NYCRR Part 358, the Department will notify eligible applicants for, or recipients of, services of their right to a fair hearing to appeal the denial, reduction or termination of a service, or the failure of the Department to act upon an application within the appropriate time frames. The Department also will inform applicants for or recipients of preventive, adoption services or kinship guardianship assistance how to make and submit a fair hearing request. The Department will provide the Agency with copies of the fair hearing decision it receives from the State of New York. The Agency, upon the request of the Department, must participate in fair hearings and any appeals thereof as witnesses when necessary for a determination of the issues.
Fair Hearings. 7.1.1 When a unit member is required to participate in a fair hearing or other due process procedure, the District shall provide the unit member with release time without loss of compensation. If the fair hearing is held after regular hours of employment, unit members shall receive their hourly rates of pay.
7.1.2 Counsel retained to represent the District in any such hearing may consult with the unit member regarding preparation for the hearing.
Fair Hearings. The Contractor understands that all applicants for services hereunder, as well as individuals declared ineligible have a right to a fair hearing regarding that determination. The Contractor hereby covenants and agrees that all applicants for services shall be permitted to fill out an application form and that each applicant or re-applicant shall be informed of his/her right to a fair hearing in accordance with Department regulations.
Fair Hearings. The PASSE must participate in the Fair Hearing process and comply with the Arkansas Administrative Procedures Act, Ark. Code Xxx. §§ 25- 15-201 et seq.
Fair Hearings i. All enrollees must have access to the state fair hearing process as required by 42 CFR §431 Subpart E. In addition, the requirements governing MCO appeals and grievances in 42 CFR §438 Subpart F shall apply for MCO covered benefits.
ii. The MCO contract shall specify whether enrollees must exhaust the MCO’s internal appeals process before exercising their right to a state fair hearing.
iii. The MCO contract shall require the MCO to make whatever reasonable accommodations are necessary to ensure that enrollees have a meaningful opportunity to exercise their appeal and grievance rights.
Fair Hearings. The hearings shall be held before a hearing officer as described above in Section VIII. The Complainant shall be afforded a fair hearing, which shall include:
(1) The opportunity to examine before the hearing any LMHA documents, including records and regulations that are directly relevant to the hearing.
(2) The right to be represented by counsel or other person chosen as the Complainant's representative and to have such person make statements on the Complainant's behalf.
(3) The right to a private hearing unless the Complainant requests a public hearing. The right to present evidence and arguments in support of the Complainant's complaint, to controvert evidence relied on by LMHA and to confront and cross examine all witnesses upon whose testimony or information the LMHA or its management relies; and
(4) A decision solely and exclusively upon the facts presented at the hearing.
Fair Hearings. 25.1 Enrollee Access to Fair Hearing Process Enrollees may access the fair hearing process in accordance with applicable federal and state laws and regulations. Contractors must abide by and participate in New York State’s Fair Hearing Process and comply with determinations made by a fair hearing officer.
25.2 Enrollee Rights to a Fair Hearing Enrollees may request a fair hearing regarding adverse LDSS determinations concerning enrollment, disenrollment and eligibility, and regarding a negative determination of the Contractor which upholds a decision by a PCP to deny a request for a referral, or to deny or reduce a benefit or service, or to authorize a service for less than requested. For issues related to disputed services, Enrollees must have received a negative Complaint determination from the Contractor confirming the decision of a Participating Provider to deny those services. An Enrollee may also seek a fair hearing for a failure by the Contractor to act with reasonable promptness with respect to Complaints about a PCP’s decision to deny a request for a referral, or to deny or reduce a benefit or service, or to authorize a service for less than requested. Reasonable promptness shall mean compliance with the timeframes established for review of Complaints in Appendix F of this Agreement and applicable Federal regulations.
Fair Hearings. The LEA is solely responsible for ensuring provision of a “free appropriate public education” (“FAPE”) to all special education students and for responding to due process complaints and related actions, except as provided by law. Although MHB will not be named by the District as a party to due process proceedings or any other complaints filed by students or by parents on behalf of their children under the IDEA’s procedural safeguards, MHB agrees to fully cooperate with the SELPA/LEA with regard to all administrative or other legal proceedings involving special education students receiving services from MHB pursuant to this MOU. MHB agrees to make available its staff as witnesses in a due process proceeding for up to 8 hours at the cost of salaries and benefits. Subsequent time will be billed to the SELPA at the $3.00 per minute rate. MHB will invoice for additional expenses if travel and lodging are required. The MHB agrees to continue providing services to any student where required under a "stay put" order issued by the Office of Administrative Hearings or by a court of competent jurisdiction. Any services provided pursuant to such an order will be reimbursed by the LEA pursuant to the terms of this Agreement.
Fair Hearings. The Contractor shall represent the Contractor’s position in fair hearings (as defined in Title 9,CCR, Section dealing with beneficiaries’ appeals of denials, modifications, deferrals or terminations of covered services. The Contractor shall carry out the final decisions of the fair hearing process with respect to issues within the scope of the Contractor’s responsibilities under this contract. Nothing in this section is intended to prevent the Contractor from pursuing any options available for appealing a fair hearing decision. U. Crosswalk between Provider System The Contractor shall comply with Title 9, CCR, Section 1840.304 when submitting claims for federal financial participation for services billed by individual or group providers using service codes from the Health Care Financing Administration’s Common Procedure Coding System (HCPCS). At such time as the table currently included in Section 1840.304 is deleted from this section, the Contractor shall follow the table issued by the Department as a DMH Information Notice.
