Kan. Admin. Regs. § 129-9-11 - Request for state fair hearing; timeliness
(a) For each request for a standard state
fair hearing under this article of the division's regulations to be considered
timely, the request shall be received by the MCE, the secretary, or the
secretary's designee for the state fair hearing according to the following time
frames:
(1) For each request by the provider
involving the MCE's action or the MCE's denial of an authorization for a new
healthcare service that was not reviewed by the external independent
third-party reviewer, the request shall be received by the MCE or the
secretary's designee for the state fair hearing within 120 days from the date
of the adequate notice of appeal resolution, pursuant to
K.S.A.
39-709h(e)(4) and amendments
thereto. If the 120th day falls on a non-business
day for the state, the time period for receipt of a request for a state fair
hearing shall be extended to the next business day on which the department is
open for business. Three days shall be added to the 120-day response period if
the notice is served by U.S. mail or electronic means. If the third day falls
on a non-business day for the state, the time period shall be extended to the
next business day on which the department is open for business.
(2) For each request by the provider
involving the MCE's action or the MCE's denial of an authorization for a new
healthcare service that was reviewed by the external independent third-party
reviewer, the request shall be received by the MCE or the secretary's designee
for the state fair hearing within 30 days from the date of the MCE's adequate
notice of external review decision, pursuant to
K.S.A.
39-709i and amendments thereto. If the
30th day falls on a non-business day for the state,
the time period for receipt of a request for a state fair hearing shall be
extended to the next business day on which the department is open for business.
Three days shall be added to the 30-day response period if the notice is served
by U.S. mail or electronic means. If the third day falls on a non-business day
for the state, the time period shall be extended to the next business day on
which the department is open for business.
(3) For each request by the provider
involving an action by the secretary, the request shall be received by the
secretary or the secretary's designee within 30 days from the date of the
secretary's adequate notice of action, pursuant to 129-9-10 . If the
30th day falls on a non-business day for the state,
the time period for receipt of a request for a state fair hearing shall be
extended to the next business day on which the department is open for business.
Three days shall be added to the 30-day response period if the notice is served
by U.S. mail or electronic means. If the third day falls on a non-business day
for the state, the time period shall be extended to the next business day on
which the department is open for business.
(b) Any provider may submit an oral or
written request for a state fair hearing with the MCE or the secretary. The
MCE, the secretary, or the secretary's designee for the state fair hearing may
require that the provider submit the request for a state fair hearing in
writing. Oral, telephonic, or electronic requests for a standard or expedited
state fair hearing may not be submitted to the secretary's designee for the
state fair hearing.
(c) Any request
for a state fair hearing made by telephone or other electronic means and
received by the MCE or the secretary during normal business hours may be
accepted as a valid request for a state fair hearing by the MCE or the
secretary if the request and proof of receipt are documented, dated, and
reduced to writing by the MCE or the secretary. The date and time of the
telephonic or electronic request for a state fair hearing shall be used to
determine the timeliness of the request even if there is a delay by the MCE or
the secretary in reducing the request to writing. Oral, telephonic, or
electronic requests for a state fair hearing may not be submitted to the
secretary's designee for the state fair hearing.
(d) Each request for a state fair hearing
received by the MCE or the secretary shall be forwarded to the secretary's
designee for the state fair hearing within one business day of
receipt.
(e) If a written request
for a state fair hearing is received by the MCE, the MCE shall date-stamp the
request when received as proof of receipt. The timeliness standards specified
in subsection (a) shall apply with the date of receipt by the MCE being used to
determine the timeliness of the request.
(f) If the provider sends a written request
for a state fair hearing directly to the secretary's designee for the state
fair hearing, the timeliness standards specified in subsection (a) shall apply
with the date of receipt by the secretary's designee being used to determine
the timeliness of the request.
(g)
If the request for a state fair hearing is not received within the response
periods specified in subsection (a), the request shall be deemed untimely and
shall be dismissed.
(h) The
presiding officer shall issue an initial order in a standard state fair hearing
within 90 days from the date the presiding officer receives a request for a
state fair hearing, except when the request for a state fair hearing involves
the issue being reviewed by the external independent third-party reviewer or
when the presiding officer allows an extension.
(i) Unless preempted by federal law, a
request for payment of a claim by a non-participating provider to a reimbursing
entity shall be treated as a request to use all applicable provisions from
statutes, regulations, policies, state plans, amendments to a state plan,
waivers, CMS-approved contracts between the secretary and the MCE, and the
provider agreements that the reimbursing entity would use in determining a
claim for reimbursement from a participating provider.
(j) The presiding officer shall issue an
initial order on each state fair hearing request within the time limits
specified in subsection (h), unless one of the following conditions is met:
(1) The presiding officer cannot reach a
decision because the appellant requests a delay or fails to take a required
action.
(2) There is an
administrative or other emergency beyond the control of the presiding officer
or the secretary. The presiding officer shall document the reasons for any
delay in the appellant's record.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.