State Fair Hearing definition
State Fair Hearing means the process set forth in subpart E of part 431 of CFR Title 42. State Fiscal Year (SFY) means 12 calendar months commencing on July 1 and ending on June 30 following or the 12-month period for which the State budgets funds.
State Fair Hearing means a hearing filed according to an Enrollee’s written request with the STATE pursuant to Minnesota Statutes, § 256.045, related to: 1) the delivery of health services by or enrollment in the MCO; 2) denial (full or partial) of a claim or service by the MCO; 3) failure by the MCO to make an initial determination in thirty (30) days; or 4) any other Action.
State Fair Hearing. A hearing conducted by the Division or its Agent in accordance with 42 C.F.R. § 431 Subpart E for applicants, Members or beneficiaries.
Examples of State Fair Hearing in a sentence
The Contractor’s failure to provide resolution of the Appeal within the required timeframe is an Adverse Benefit Determination and the Aggrieved Person is allowed to file a request for a State Fair Hearing as the Aggrieved Person has already exhausted the Contractor’s internal Appeals process.
Monthly; No later than the15th MLTC Reporting Database: Grievance Log Data regarding the grievances received by the MCOs. Monthly; No later than the15th MLTC Reporting Database: Appeals Log Data regarding the appeals received by the MCOs. Monthly; No later than the15th MLTC Reporting Database: State Fair Hearing Log Data regarding the state fair hearings.
You may request a State Fair Hearing if you are dissatisfied with your appeals decision.
The Contractor shall also attach to the Notice of Adverse Benefit Determination a copy of the State Fair Hearing request form that the Aggrieved Person can submit to request a State Fair Hearing.
If the matter is still not resolved to the member's satisfaction, the member may file an external appeal (medical review) and/or a State Fair Hearing.
More Definitions of State Fair Hearing
State Fair Hearing means an appeal to AHS for a hearing before the Human Services Board.
State Fair Hearing. An Appeal filed for Medicaid services with the State Board of Hearings.
State Fair Hearing. The process used by the Wisconsin Division of Hearing and Appeals to adjudicate member appeals of anadverse benefit determination.
State Fair Hearing means the administrative hearing provided by the Cabinet pursuant to KRS Chapter 13B and contained in 907 KAR 17.010. Subcontract means any agreement entered into, directly or indirectly, by a Contractor to delegate the responsibility of any major service or group of services, including administrative functions or Covered Services, specifically related to securing or fulfilling the Contractor’s obligations under this Contract. Administrative functions are any requirements under this Contract other than the direct provision of services to Enrollees such as, but not limited to, utilization or medical management, Claims processing, Enrollee grievances and appeals, and the provision of data or information necessary to fulfill Contractor obligations. Subcontractor means any individual or entity other than a Provider, Physician Health Organization, or Network Provider, with which Contractor has entered into a written agreement for the purpose of fulfilling a Contractor’s obligations under an MCO Contract. Supplemental Security Income (SSI) is a program administered by the Social Security Administration (SSA) that pays benefits to disabled adults and children who have limited income and resources. SSI benefits are also payable to people sixty-five (65) and older without disability who meet the financial limits. Symmetrical Risk Corridor means the same size corridors of risk sharing percentages above and below a target amount designed to limit exposure to unexpected expenses. Taxonomy codes reference codes designed to categorize the type, classification, and/or specialization of health care providers. Health care providers must select the relevant code(s) when applying for a National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES).
State Fair Hearing means a review by the State of an adverse benefit determination at the request of a beneficiary who has received notice that the adverse benefit determination was upheld.
State Fair Hearing. Impartial state level review of a Medicaid Consumer’s appeal of an adverse benefit determination presided over by a MDHHS Administrative Law Judge. Also referred to as "Administrative Hearing". The State Fair Hearing Process is set forth in detail in Subpart E of 42 CFR Part 431. Subrecipient means an entity that expends awards received from a pass-through entity to carry out a project. As defined by Office of Management and Budget (OMB) 2 Code of Federal Regulations (CFR) 200 Subpart A, a subrecipient relationship exists when funding from a pass-through entity is provided to perform a portion of the scope of work or objectives of the pass-through entity’s award agreement with the awarding agency. A pass- through entity is an entity that provides an award to a subrecipient to carry out a project. For purposes of this agreement, “subrecipient” refers to the Provider named on this agreement, whereas “pass-through entity” refers to MSHN. See OMB 2 CFR 200 Subpart A for further information. SUDPDS means Substance Use Disorder Prevention Data System (also referred to as MPDS), is the State’s web-based data system that captures all direct funded prevention services and specific recovery-based services and community out-reach services. Support Services are those readily available to the program through affiliation, contract or because of their availability to the community at large (for example, 911 emergency response services). They are used to provide services beyond the capacity of the staff of the program on a routine basis or to augment the services provided by the staff. Transfer is the movement of the client from one level of service to another or from one provider to another within the continuum of care. Treatment is the application of planned procedures to identify and change patterns of behavior that are maladaptive, destructive and/or injurious to health; or to restore appropriate levels of physical, psychological and/or social functioning. FY 2021 CONTRACTUAL AGREEMENT
State Fair Hearing. The process used by the Wisconsin Division of Hearing and Appeals to adjudicate member appeals of HMO adverse benefit determinations. Subcontract: Any written agreement between the HMO and another party to fulfill the requirements of this Contract. However, such terms do not include insurance purchased by the HMO to limit its loss with respect to an individual member, provided the HMO assumes some portion of the underwriting risk for providing health care services to that member. Substantial Failure to Perform: Includes any violation of any requirement of this Contract that is repeated or ongoing, that goes to the essentials or purpose of the Contract, or that injures, jeopardizes or threatens the health, safety, welfare, rights or other interests of members. Third Party Liability (TPL): The legal obligation of a third party (other than Medicaid) to pay for part or all of a claim. Since Medicaid is legally the “payer of last resort,” the identification of other payer obligations is a major requirement in the adjudication of claims (see Addendum IV, A for additional definitions pertaining to TPL). Trade Secret: Per Wis. Stat. §134.90(1), trade secrets are information, including a formula, pattern, compilation, program, device, method, technique or process to which all of the following apply: