California Code of Regulations
Title 10 - Investment
Chapter 12 - California Health Benefit Exchange
Article 7 - Appeals Process for the Individual Exchange
Section 6610 - Dismissals

Universal Citation: 10 CA Code of Regs 6610

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

(a) The appeals entity shall dismiss an appeal if the appellant:

(1) Unconditionally or conditionally withdraws the appeal request in writing prior to the hearing date, in accordance with the following procedure:
(A) Except as provided in subdivision (a)(1)(B) of this section, if the withdrawal is unconditional, the appeal request shall be immediately dismissed.

(B) If the appellant has verbally withdrawn their appeal request prior to the hearing, and such withdrawal is unconditional, the following process shall apply:
1. The appeals entity shall send the appellant a written confirmation of the withdrawal within five business days from the date on which the appellant's verbal withdrawal request is received by the appeals entity. The written confirmation shall serve as the appellant's written withdrawal and the appeal shall be dismissed unless the appellant notifies the appeals entity, in writing or verbally, within 15 days of the date of the written confirmation, that the appellant has not withdrawn their appeal request.

2. If the appellant makes the verbal unconditional withdrawal request to the Exchange, the Exchange shall notify the appeals entity of the appellant's verbal unconditional withdrawal request within three business days from the date of the request.

(C) If the withdrawal is conditional:
1. The withdrawal shall be accompanied by an agreement signed by the appellant and by the Exchange as part of the informal resolution process specified in Section 6612;

2. Upon receipt of the signed conditional withdrawal, the hearing date, if any, shall be vacated;

3. The actions of both parties under the agreement specified in subdivision (a)(1)(C)1 of this section shall be completed within 30 calendar days of the date on the agreement; and

4. Upon the satisfactory completion of the actions of the appellant and the Exchange under the agreement specified in subdivision (a)(1)(C)1 of this section, the appeals entity shall dismiss the appeals request unless the hearing request is reinstated within the time limits set forth in Section 6606(c);

(D) Both unconditional and conditional withdrawals shall be accepted by telephone if the following requirements are met:
1. The appellant's statement and telephonic signature made under penalty of perjury shall be recorded in full; and

2. The appeals entity shall provide the appellant with a written confirmation documenting the telephonic interaction.

(2) Fails to appear at a scheduled hearing without good cause, as determined in accordance with Section 6602(c);

(3) Fails to submit a valid appeal request as specified in Section 6606(b) without good cause, as determined in accordance with Section 6602(c); or

(4) Dies while the appeal is pending, unless the appeal affects the remaining member(s) of the deceased appellant's household, or the appeal can be carried forward by a representative of the deceased appellant's estate, or by an heir of the deceased appellant if the decedent's estate is not in probate, in accordance with the California Department of Social Services' Manual of Policies and Procedures Section 22-004.4.

(b) If an appeal is dismissed under subdivision (a) of this section, the appeals entity shall provide written notice to the appellant within five business days from the date of the dismissal. The notice shall include:

(1) The reason for the dismissal;

(2) An explanation of the dismissal's effect on the appellant's eligibility; and

(3) An explanation of how the appellant may show good cause as to why the dismissal should be vacated in accordance with subdivision (d) of this section.

(c) If an appeal is dismissed under subdivision (a) of this section, the appeals entity shall, within three business days from the date of the dismissal, provide notice of the dismissal to the Exchange, and to the DHCS, as applicable, including instructions to, no earlier than five business days from the date of the dismissal:

(1) Implement the eligibility determination; and

(2) Discontinue eligibility pending appeal provided under Section 6608.

(d) The appeals entity shall:

(1) Vacate a dismissal and proceed with the appeal if the appellant makes a written request within 30 calendar days of the date of the notice of the dismissal showing good cause why the dismissal should be vacated, in accordance with Section 6602(c); and

(2) Provide written notice of the denial of a request to vacate a dismissal to the appellant within five business days from the date of such denial, if the request is denied.

Note: Authority cited: Section 100504, Government Code. Reference: Sections 100503 and 100506, Government Code; and 45 CFR Section 155.530.

Note: Authority cited: Section 100504, Government Code. Reference: Sections 100503 and 100506, Government Code; and 45 CFR Section 155.530.

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.