Utah Admin. Code R986-100-137 - Hearings on Determinations of Medical Assistance Eligibility
(1)
(a) The Department has been designated by the
Utah Department of Health and Human Services to determine eligibility for
medical assistance, as authorized by the following:
(i)
42 U.S.C.
1396a;
(ii)
42 C.F.R.
431.10;
(iii) Section 26-18-5 of the Utah Code;
and
(iv) Section
R414-301-2.
(b) The Department of Health and Human
Services administers Medicaid and other medical assistance benefits
programs.
(2)
(a) An adversely affected party may request a
fair hearing to review a decision of medical assistance eligibility.
(b) Except as stated in this rule, a fair
hearing request follows the procedures of Sections
R986-100-123 through
R986-100-135.
(3) A hearing may be requested by:
(a) a client;
(b) a client's spouse;
(c) a parent or guardian of a minor client;
or
(d) an authorized guardian or
representative of a client.
(4)
(a) A
representative from DWS shall participate in hearings.
(b) Representatives from other state agencies
may participate as needed.
(5)
(a) If
the ALJ or hearing officer's decision is not appealed for agency review as
provided in Section R986-100-138, the decision
becomes final 30 days after the decision is issued.
(b) The parties may stipulate to an earlier
effective date, if no appeal will be requested.
(c) If the ALJ or hearing officer reverses
the eligibility decision, the Department of Health and Human Services will
comply with the ALJ or hearing officer's decision after the decision becomes
final.
(6)
(a)
(i) A
recipient of medical assistance benefits may continue to receive benefits
pending a hearing decision if the recipient requests the hearing before the
effective date of the eligibility determination or within 15 days on the notice
of eligibility determination.
(b) A recipient may decline the continued
benefits while a hearing is pending by notifying the Department of Health and
Human Services in writing.
(c) A
recipient must repay any benefits received while a hearing is pending if a
decision denying eligibility is upheld.
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.