California Code of Regulations
Title 10 - Investment
Chapter 12 - California Health Benefit Exchange
Article 7 - Appeals Process for the Individual Exchange
Section 6614 - Hearing Requirements

Universal Citation: 10 CA Code of Regs 6614

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

(a) An appellant shall have an opportunity for a hearing in accordance with the requirements of this section.

(b) When a hearing is scheduled, the appeals entity shall send written notice to the appellant and the appellant's authorized representative, if any, of the date, time, location, and format of the hearing no later than 15 days prior to the hearing date unless:

(1) The appellant requests an earlier hearing date; or

(2) A hearing date sooner than 15 days is necessary to process an expedited appeal, as described in Section 6616(a), and the appeals entity has contacted the appellant to schedule a hearing on a mutually agreed upon date, time, and location or format.

(c) The hearing shall be conducted:

(1) Within 90 days from the date on which a valid appeal request is received, except for the expedited appeals specified in Section 6616;

(2) After notice of the hearing, pursuant to subdivision (b) of this section;

(3) As an evidentiary hearing, consistent with subdivision (e) of this section;

(4) By an administrative law judge who has not been directly involved in the eligibility determination or any prior Exchange appeal decisions in the same matter; and

(5) By telephone, video conference, or in person, in accordance with the California Department of Social Services' Manual of Policies and Procedures Section 22-045.1.

(d) The appeals entity shall provide the appellant with the opportunity to:

(1) Review their appeal record, including all documents and records to be used by the appeals entity at the hearing, at least two business days before the date of the hearing as well as during the hearing;

(2) Bring witnesses to testify;

(3) Establish all relevant facts and circumstances;

(4) Present an argument without undue interference;

(5) Question or refute any testimony or evidence, including the opportunity to confront and cross-examine adverse witnesses; and

(6) Be represented by an authorized representative, legal counsel, a relative, a friend, or another spokesperson designated by the appellant.

(e) The appeals entity shall consider the information used to determine the appellant's eligibility as well as any additional relevant evidence presented during the appeal process, including at the hearing.

(f) The appeals entity shall review the appeal de novo and shall consider all relevant facts and evidence presented during the appeal.

(g) Postponements and continuances shall be conducted in accordance with the California Department of Social Services' Manual of Policies and Procedures Section 22-053.

Note: Authority cited: Section 100504, Government Code. Reference: Sections 100503 and 100506, Government Code; and 45 CFR Section 155.535.

Note: Authority cited: Section 100504, Government Code. Reference: Sections 100503 and 100506, Government Code; and 45 CFR Section 155.535.

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.