Utah Admin. Code R986-100-138 - Agency Review of Medical Assistance Eligibility
(1) An adversely affected party, including
the Department of Health and Human Services, may appeal an ALJ or hearing
officer decision by requesting agency review.
(2) A request for agency review must be made
within 30 days after the decision is issued. An untimely request for agency
review will be dismissed unless the requesting party can show good cause for
the untimely request pursuant to Subsection R986-10-131(2).
(3) The Executive Director of the Department
or the Executive Director's designee shall conduct the agency review.
(4) Agency review is an informal proceeding
and shall be conducted in accordance with Section
63G-4-301.
(a) The ALJ or hearing officer's decision is
suspended until the Executive Director or their designee issues a final
decision and order on agency review.
(b) A hearing will not be conducted for
agency review.
(c) A party may
submit written comments or arguments within 10 days following notice of the
agency review.
(d) The agency
review may confirm, reverse, or modify the ALJ or hearing officer's
decision.
(5)
(a) Benefits may continue while an agency
review is pending.
(b) A recipient
may decline the continued benefits while agency review is pending by notifying
the Department of Health and Human Services in writing.
(c) A recipient must repay any benefits
received while agency review is pending if a decision denying eligibility is
upheld.
(6) A decision
on agency review is final upon issuance.
(7) The Department of Health and Human
Services shall take case action within ten calendar days of the date the agency
review decision becomes final.
Notes
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