State Fair Hearing. See Administrative Law Hearing Subcontract: Any written contract between the Contractor and a third party, including a Provider, to perform a specified part of the Contractor’s obligations under this Contract.
State Fair Hearing. Medicaid consumers who request or receive services that are paid for with Medicaid funds per Michigan’s approved use of Section (a)(1)(A) of the Social Security Act will be provided an Adverse Benefit Determination when services are denied, reduced, suspended or terminated. Consumers must exercise their right to a local appeal process before requesting their right to a State Fair Hearing.
State Fair Hearing. A “state fair hearing” is a quasi-judicial proceeding conducted by a judge, during which each hearing party may present arguments and evidence, including witness(es), and cross examine witness(es) against them, with respect to a decision regarding the availability or delivery of services or benefits, made by an agency. An “agency” is a government unit or managed care health plan involved in a hearing as a hearing party. Such agencies include all 58 California counties, the Los Angeles Department of Children and Family Services, the California Department of Aging, the CDSS Office of Services to the Blind, all 27 Medi- Cal Field Offices, and several CDHS units, including: Beneficiary Utilization Review Unit, Benefits Branch-Vision, In-Home Operations, Managed Care Operations Branch, Recovery Section, and Office of Medi-Cal Dental Services.
State Fair Hearing. A hearing conducted by the Division or its Agent in accordance with 42 C.F.R. § 431 Subpart E for applicants, Members or beneficiaries.
State Fair Hearing. An impartial review of a decision made by the MDHHS or one of its contract agencies which is conducted by a Michigan Administrative Hearings System (MAHS) Administrative Law Judge under the oversight, supervision, and authority of MDHHS so as to provide due process rights required by applicable law.
State Fair Hearing. In most cases, the beneficiaries must exhaust the internal appeal prior to making a State fair hearing request, unless exhaustion is deemed as set forth above. A beneficiary who seeks review of a service not subject to the internal appeal process pursuant to HCAE 8.100.1 does not have to exhaust the internal appeal process. DVHA will accept a timely request for a State fair hearing from an enrollee and will process the request without delay. A timely request for a State fair hearing means that an enrollee has requested the State fair hearing: within 120 days of the date the notice of resolution of the internal appeal was mailed to the enrollee by DVHA (mailing is the postmark date which is considered one business day after the date of the notice), or, if there was no internal appeal (for those services for which the internal appeal process does not apply), then within 120 days after the mailing of the notice of adverse benefit determination. . Beneficiaries have the right to file requests for State fair hearings related to eligibility and premium determinations. AHS shall retain responsibility for representing the State in any fair hearings pertaining to such eligibility and premium determinations. Hearing descriptions must be included in enrollee and provider information within the contract. A provider who is an authorized representative may request a State fair hearing. − Beneficiaries also have the right to file a request for an expedited State fair hearing after exhausting the internal appeal process for expedited appeals, unless exhaustion is deemed for the reasons described above. The beneficiary, his/her representative, or the representative of a deceased enrollee’s estate shall be parties to a State Fair Hearing. Expedited State fair hearings shall be resolved as expeditiously as the enrollee’s health condition requires, but no later than 3 working days after the agency (the Human Services Board) received the case record and information for an appeal that DVHA indicates meets the standard for an expedited appeal. When the matter is not expedited (i.e., standard resolution), the final administrative decision must be sent to the beneficiary within 90 days from the date the beneficiary filed the internal appeal, not counting the number of days the beneficiary took to subsequently file for a State fair hearing.
State Fair Hearing. A hearing conducted by the Division of Medicaid or its Agent in accordance with 42 C.F.R. § 431 Subpart E.
State Fair Hearing. Providers must exhaust UHC appeal process prior to submitting a State Fair Hearing.
State Fair Hearing. If you disagree with the outcome of your appeal by UnitedHealthcare Community Plan, you can request a State Fair Hearing. You may only file for a State Fair Hearing after you have completed the formal appeal process with UnitedHealthcare Community Plan. You may choose someone, including an attorney, to represent you and act on your behalf. UnitedHealthcare Community Plan does not cover any fees or payment to your representation.
