Common use of State Fair Hearing Clause in Contracts

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. 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 With the written consent of the beneficiary, a provider who is or an authorized representative may request a State fair hearinghearing on behalf of the beneficiary. − 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. 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 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 state fair hearing: within 120 90 days of the date the notice of resolution of the internal appeal action was mailed to the enrollee by DVHA (mailing is the postmark date which is considered one business day after the date of the notice)DVHA, or, if there was no internal appeal (for those services for which the internal appeal process does not apply)mailing, then within 120 90 days after the mailing action occurred. DVHA will consider as timely a request from an enrollee for a fair hearing following a DVHA appeal decision if it is made within 90 days of the date the original notice of action or within 30 days of the date the notice of the DVHA appeal decision. DVHA will continue to provide continuing benefits to an enrollee if the original request for a DVHA appeal or a state fair hearing was filed before the effective date of the adverse benefit determination. action and the enrollee has paid in full any required premiums, the enrollee’s services will continue. 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 abovehearing. The beneficiary, his/her representative, or the representative of a deceased enrollee’s estate shall be parties to a State Fair Hearing. Expedited State 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 information noted at 431.244(f)(2). If DVHA takes action 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)enrollee requests a State Fair Hearing, the final administrative decision State (not DVHA) must grant the enrollee a State Fair Hearing. The right to a state fair hearing, how to obtain a hearing, and representation rules at a hearing must be sent explained to the beneficiary within 90 days from enrollee and provider by DVHA (if they have delegated authority) or by the date State (if the beneficiary filed the internal appeal, State has not counting the number of days the beneficiary took to subsequently file for a State fair hearingdelegated that authority).

State Fair Hearing. In most cases, the beneficiaries Enrollees must exhaust the internal appeal rights prior to making a State fair hearing 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 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 state fair hearing: within 120 90 days of the date the notice of resolution of the internal appeal action was mailed to the enrollee by DVHA (mailing is the postmark date which is considered one business day after the date of the notice)DVHA, or, if there was no internal appeal (for those services for which the internal appeal process does not apply)mailing, then within 120 90 days after the mailing action occurred. DVHA will consider as timely a request from an enrollee for a fair hearing following a DVHA appeal decision if it is made within 90 days of the date the original notice of action or within 30 days of the date the notice of the DVHA appeal decision. DVHA will continue to provide continuing benefits to an enrollee if the original request for a DVHA appeal or a state fair hearing was filed before the effective date of the adverse benefit determination. action and the enrollee has paid in full any required premiums, the enrollee’s services will continue. 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 abovehearing. The beneficiary, his/her representative, or the representative of a deceased enrollee’s estate shall be parties to a State Fair Hearing. Expedited State 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 information noted at 431.244(f)(2). If DVHA takes action 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)enrollee requests a State Fair Hearing, the final administrative decision State (not DVHA) must grant the enrollee a State Fair Hearing. The right to a state fair hearing, how to obtain a hearing, and representation rules at a hearing must be sent explained to the beneficiary within 90 days from enrollee and provider by DVHA (if they have delegated authority) or by the date State (if the beneficiary filed the internal appeal, State has not counting the number of days the beneficiary took to subsequently file for a State fair hearingdelegated that authority).