Common use of State Fair Hearing Process Clause in Contracts

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.

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 thirty-three (6033) 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 3 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- 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.