Medicaid Fair Hearing definition

Medicaid Fair Hearing means the formal process following an action that would terminate, suspend, reduce, or deny a Medicaid service. This is a formal process required by federal law (42 CFR 431.200-250). A Medicaid Fair Hearing is also known as a contested case hearing.
Sample 1Sample 2Sample 3
Medicaid Fair Hearing. An administrative hearing conducted by the Agency to review an action taken by a Managed Care Plan that limits, denies, or stops a requested service.
Sample 1Sample 2
Medicaid Fair Hearing means the formal process following an action that would terminate, suspend, reduce or deny a Medicaid service. This is a formal process required by federal law (42 CFR 431.200-250).
Sample 1Sample 2Sample 3

Examples of Medicaid Fair Hearing in a sentence

  • The access system shall provide Medicaid, ABW and MIChild beneficiaries information about the local dispute resolution process and the state Medicaid Fair Hearing process26.

  • The access system shall provide Medicaid and MIChild beneficiaries information about the local dispute resolution process and the state Medicaid Fair Hearing process14.

  • Additionally, Service Provider agrees to comply with the Authority's policies on dispute resolution grievance and appeals technical requirements (as provided in the Authority’s Provider Manual); Medicaid Fair Hearing and appeals rights and procedures; Recipient Rights; rights to a second opinion; mediation; local/informal and alternate dispute resolution processes; rights to a review of an individual’s treatment plan; and rights to request an independent plan facilitator.

  • Enrollees dissatisfied with an Agency determination may request a Medicaid Fair Hearing.

  • Components must include a complaint process, a grievance process, an appeal process, access to an applicable review outside the Managed Care Plan (Subscriber Assistance Program), and access to a Medicaid Fair Hearing through the Agency.

  • The Managed Care Plan shall ensure that enrollees are notified of their rights and responsibilities; the role of PCPs; how to obtain care; what to do in an emergency or urgent medical situation; how to pursue a complaint, a grievance, plan appeal or Medicaid Fair Hearing; how to report suspected fraud and abuse; how to report abuse, neglect and exploitation; and all other requirements and benefits of the Managed Care Plan.

  • Should an enrollee appeal a Medicaid Fair Hearing final order to the appropriate District Court of Appeal (DCA), the Managed Care Plan must fully participate in the appellate process.

  • The Commission and the STP shall have a Grievance System in place that includes a Complaint process, a Grievance process, an Appeal process, and access to the Medicaid Fair Hearing system.

  • The Health Plan shall have a Grievance System in place that includes a Grievance process, an Appeal process and access to the Medicaid Fair Hearing system.

  • In addition to the required information on the notice of final disposition, procedural steps for requesting a Medicaid Fair Hearing must be clearly specified in the member handbook and the provider manual for providers and must be shared with members upon enrollment and providers upon entrance into a provider subcontract.

Related to Medicaid Fair Hearing

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicaid program means the medical assistance

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Enrollee means any person entitled to health care services from a carrier.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Newborn means a baby less than nine days old.

  • HMO means health maintenance organization.

  • Licensed health care practitioner means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets requirements prescribed by the Secretary of the Treasury.

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

  • AHCCCS means the Arizona Health Care Cost Containment System.

  • Privacy Commissioner means the person occupying the position of Privacy Commissioner from time to time pursuant to the Privacy Xxx 0000.

  • Health care practitioner means an individual licensed

  • Licensed health care professional means a person who possesses a professional medical license that is valid in Oregon. Examples include, but are not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant (PA), or occupational therapist (OT).