42 CFR 457.1130 - Program specific review process: Matters subject to review.
(a) Eligibility or enrollment matter. A State must ensure that an applicant or enrollee has an opportunity for review, consistent with §§ 457.1140 and 457.1150, of a—
(3) Suspension or termination of enrollment, including disenrollment for failure to pay cost sharing.
(b) Health services matter. A State must ensure that an enrollee has an opportunity for external review of a—
(1) Delay, denial, reduction, suspension, or termination of health services, in whole or in part, including a determination about the type or level of services; and
(c) Exception. A State is not required to provide an opportunity for review of a matter described in paragraph (a) or (b) of this section if the sole basis for the decision is a provision in the State plan or in Federal or State law requiring an automatic change in eligibility, enrollment, or a change in coverage under the health benefits package that affects all applicants or enrollees or a group of applicants or enrollees without regard to their individual circumstances.
Title 42 published on 2013-10-01
no entries appear in the Federal Register after this date.