Cal. Code Regs. Tit. 10, § 6662 - Appeals Process

(a) Other than a determination made pursuant to Section 6658, Certified Enrollment Counselor Fingerprinting and Criminal Record Checks, a decision that an individual or entity is not eligible or qualified to participate or continue to participate in a program under this Article may be appealed to the Exchange in accordance with the requirements of this Section.

(b) The Exchange shall allow an applicant to request an appeal within 60 calendar days of the date of the notice of eligibility determination.

(c) The first phase of the Appeals Process shall include an informal review by the Exchange. The Exchange shall consider the information used to determine the appellant's eligibility as well as any additional relevant evidence presented during the course of the appeal. The Exchange shall make an informal resolution decision within 45 calendar days from the receipt of the appeal. The Exchange shall notify the appellant in writing of the decision.

(d) If the appellant is satisfied with the outcome of the informal resolution decision, the appeal may be withdrawn. If the appeal is not withdrawn, it shall be automatically escalated to the second phase of the Appeals Process. During the second phase, an independent unit within the Exchange that had no involvement in the original eligibility or qualification determination or informal resolution decision shall review the eligibility or qualification of the appellant de novo. The appellant shall be allowed to present additional evidence during the second phase. The Exchange shall consider all relevant evidence presented during the course of the appeal and notify the appellant in writing of the final decision within 60 calendar days from the receipt of the appeal.

Notes

Cal. Code Regs. Tit. 10, § 6662

Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 C.F.R. §§ 155.205 155.210 and 155.215.

1. New section filed 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1(g) (Register 2014, No. 7).
3. New section filed 2-10-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be repealed by operation of law on the following day.
4. New section refiled 5-12-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of Compliance must be transmitted to OAL by 8-11-2014 or emergency language will be repealed by operation of law on the following day.
5. New section refiled 7-21-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 ( Stats 2014, c. 31 ); operative 7/21/2014 (Register 2014, No. 30). A Certificate of Compliance must be transmitted to OAL by 7-15-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.