Or. Admin. R. 410-141-3905 - Grievances & Appeals: Expedited Contested Case Hearings
Current through Register Vol. 60, No. 12, December 1, 2021
(1) An MCE shall
have a system in place to ensure its members and providers have access to
expedited review for MCE's action by requesting an expedited contested case
hearing. Contested case hearings are conducted pursuant to ORS
183.411
to
183.497
and the Attorney General's Uniform and Model Rules of Procedure for the Office
of Administrative Hearings, OAR 137-003-0501 to 137-003-0700. Processes for
expedited contested case hearings are provided in OAR 410-120-1860 Contested
Case Hearing Procedures.
(2) A
member or provider who believes that taking the time for a standard resolution
of a request for a contested case hearing could seriously jeopardize the
member's life or health or ability to attain, maintain, or regain maximum
function may request an expedited contested case hearing.
(3) A request for an expedited hearing for a
service that has already been provided (post-service) to the member will not be
granted.
(4) The member may not
request an expedited contested case hearing without first completing an appeal
or expedited appeal with the MCE, subject to the exception in OAR
410-141-3900(3). When a member files a hearing request prior to completion of
an MCE appeal or expedited appeal, the Authority shall follow procedures set
forth in OAR 410-141-3900.
(5)
Expedited hearings are requested using Authority form MSC 443 or other
Authority-approved appeal or hearing request forms.
(6) The MCE shall submit relevant
documentation to the Authority within two working days. The Authority shall
decide within two working days from the date of receiving the relevant
documentation whether the member is entitled to an expedited contested case
hearing.
(7) If the Authority
denies a request for an expedited contested case hearing, the Authority shall:
(a) Handle the request for a contested case
hearing in accordance with OAR 410-120-1860; and
(b) Make reasonable efforts to give the
member prompt oral notice of the denial and follow up within two days with a
written notice.
(8) If a
member requests an expedited hearing, the Authority shall request documentation
from the MCE, and the MCE shall submit relevant documentation including
clinical documentation to the Authority within two working days.
Notes
Statutory/Other Authority: ORS 413.042 & ORS 414.065
Statutes/Other Implemented: ORS 414.065 & 414.727
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