Utah Admin. Code R410-14-4 - Hearings
(1) DIH shall
conduct informal hearings for issues except those specifically designated as
formal hearings pursuant to this rule. The hearing officer may convert the
proceeding to a formal hearing if an aggrieved person requests a hearing that
meets the criteria set forth in Section
63G-4-202.
(2) If a hearing under this rule is converted
to a formal hearing pursuant to Section 63G-4-202, the formal hearing must be
conducted in accordance with these criteria except as otherwise provided in
Sections 63G-4-204 through
63G-4-208 or other applicable
statutes.
(3) DIH shall conduct a
hearing in connection with an agency action if the aggrieved person requests a
hearing and there is a disputed issue of fact. If there is no disputed issue of
fact, the hearing officer may deny a request for an evidentiary hearing and
issue a recommended decision without a hearing based on the record. In the
recommended decision, the hearing officer shall specifically set out all
material and relevant facts not in dispute.
(4) There is no disputed issue of fact if the
aggrieved person submits facts that do not conflict with the facts that the
agency relies upon in taking action or seeking relief.
(5) If the aggrieved person objects to the
hearing denial, the person may raise that objection as grounds for relief in a
request for reconsideration.
(6) An
MCO may not require an aggrieved person to utilize arbitration or mediation to
resolve an action. An aggrieved person may file a request for hearing relating
to an action regardless of any contractual provision with an MCO that may
require arbitration or mediation.
(7) The hearing officer may not grant a
hearing if the issue is a state or federal law requiring an automatic change in
eligibility for medical assistance or covered services that affect the
aggrieved person.
Notes
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