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.
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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.
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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).
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Examples of Medicaid Fair Hearing in a sentence

  • The Health Plan shall ensure that Enrollees are aware 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 request a Grievance, Appeal or Medicaid Fair Hearing, how to report suspected Fraud and Abuse, procedures for obtaining required Behavioral Health Services, including any additional Health Plan phone numbers to be used for obtaining services, and all other requirements and Benefits of the Health Plan.

  • The Health Plan shall provide any reasonable help to the enrollee in completing forms and following the procedures for filing a grievance or appeal or requesting a Medicaid Fair Hearing.

  • If the Medicaid Fair Hearing officer reverses the Health Plan’s action and the enrollee received the disputed services while the appeal was pending, the Health Plan shall pay for those services in accordance with this Contract.

  • If the Medicaid Fair Hearing officer reverses the Health Plan’s action and services were not furnished while the appeal was pending, the Health Plan shall authorize or provide the disputed services promptly.

  • 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.

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

  • An enrollee who chooses to exhaust the Health Plan’s grievance and appeal process may still file for a Medicaid Fair Hearing within ninety (90) calendar days of receipt of the Health Plan’s notice of resolution.

  • Parties to the Medicaid Fair Hearing include the Health Plan as well as the enrollee or that person’s authorized representative.

  • An enrollee may seek a Medicaid Fair Hearing without having first exhausted the Health Plan’s grievance and appeal process.

  • An enrollee who chooses to seek a Medicaid Fair Hearing without pursuing the Health Plan’s process must do so within ninety (90) days of receipt of the Health Plan’s notice of action.