California Code of Regulations
Title 10 - Investment
Chapter 12 - California Health Benefit Exchange
Article 6 - Application, Eligibility, and Enrollment in the Shop Exchange
Section 6550 - Expedited Appeal Process

Universal Citation: 10 CA Code of Regs 6550

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) An appellant shall have the right to request an expedited appeals process from the appeals entity where there is an immediate need for health coverage or dental coverage because a standard appeal could jeopardize the appellant's life or health, or ability to attain, maintain, or regain maximum function.

(b) If the appeals entity denies a request for an expedited appeal, it shall:

(1) Handle the appeal request under the standard appeals process and issue the appeal decision in accordance with Section 6552; and

(2) Inform the appellant, within three (3) business days from the date of the denial of a request for an expedited appeal, through electronic, or oral notification if possible, of the denial and, if notification is oral, follow up with the appellant by written notice within five (5) business days of the denial. Written notice of the denial shall include:
(A) The reason for the denial;

(B) An explanation that the appeal request will be administered pursuant to the standard appeals process; and

(C) An explanation of the appellant's rights under the standard appeals process.

(c) If the appeals entity grants a request for an expedited appeal, it shall:

(1) Ensure a hearing date is set on an expedited basis;

(2) Provide the appellant with written notice within 10 calendar days from the date on which the appellant's request for an expedited appeal is granted, informing the appellant:
(A) That his or her request for an expedited appeal is granted; and

(B) About the date, time, and type of the hearing that will be convened.

(3) Within three (3) business days from the date on which the appellant's request for an expedited appeal is granted, provide notice via secure electronic interface to the SHOP, specifying that the appellant's request for an expedited appeal is granted and a hearing will be set on an expedited basis.

1. New section filed 12-3-2013 as an emergency; operative 12-3-2013 (Register 2013, No. 49). A Certificate of Compliance must be transmitted to OAL by 6-2-2014 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 6-2-2014 as an emergency; operative 6-2-2014 (Register 2014, No. 23). A Certificate of Compliance must be transmitted to OAL by 9-2-2014 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 9-2-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-2-2014 (Register 2014, No. 36). A Certificate of Compliance must be transmitted to OAL by 12-3-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
4. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 12-5-2016 or the language in the emergency order of 9-2-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
5. Certificate of Compliance as to 9-2-2014 order transmitted to OAL 5-4-2016 and filed 6-14-2016 (Register 2016, No. 25).
6. Amendment of subsection (a) filed 9-7-2021 as an emergency; operative 9-7-2021 (Register 2021, No. 37). Pursuant to Government Code section 100504(a)(6)(A), a Certificate of Compliance must be transmitted to OAL by 9-7-2026 or emergency language will be repealed by operation of law on the following day.

Note: Authority cited: Section 100504, Government Code. Reference: Section 100506, Government Code; and 45 CFR § 155.740.

Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.