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. 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.

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 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.