Utah Admin. Code R382-1-8 - Agency Conferences, Fair Hearings, and Appeals
(1) A CHIP applicant or beneficiary may
request an agency conference in accordance with Section
R414-301-5
at any time to resolve a problem without requesting an agency action under the
Utah Administrative Procedures Act (UAPA).
(2) The CHIP applicant or beneficiary,
parent, legal guardian, or authorized representative may request an agency
action, also called a fair hearing, if the individual disagrees with an agency
decision regarding the individual's eligibility. The request for a fair hearing
must be in accordance with Section
R414-301-7.
(3) The Department of Workforce Services
shall conduct fair hearings on eligibility in accordance with Section
R414-301-7.
(4) If a CHIP beneficiary disagrees with a
decision of the MCO regarding a covered benefit or service, the beneficiary may
appeal the decision through the MCO.
(a) A C
H I P beneficiary must exhaust grievance remedies with the MCO before the
beneficiary requests an agency action from the Department.
(b) The CHIP beneficiary may file an appeal
with the Department if the beneficiary disagrees with the MCO's resolution. The
beneficiary must file the appeal within 60 days of the date that the MCO sends
the resolution notice.
(c) The
Department shall conduct a review of the MCO's decision in accordance with
42 CFR
438.408 and issue a final decision to the
CHIP beneficiary and the MCO.
(d)
The Department shall conduct all appeals in accordance with UAPA.
(e) The CHIP beneficiary may continue to
receive benefits if the beneficiary meets the conditions of
42
CFR 438.420.
Notes
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