California Code of Regulations
Title 10 - Investment
Chapter 12 - California Health Benefit Exchange
Article 8 - Enrollment Assistance
Section 6662 - Appeals Process
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Other than a determination made pursuant to Section 6658, a decision that an individual or entity is not eligible or qualified to participate or continue to participate in a program under this Article may be appealed to the Exchange in accordance with the requirements of this Section.
(b) The Exchange shall allow an applicant to request an appeal within 60 calendar days of the date of the notice of eligibility determination.
(c) The first phase of the Appeals Process shall include an informal review by the Exchange. The Exchange shall consider the information used to determine the appellant's eligibility as well as any additional relevant evidence presented during the course of the appeal. The Exchange shall make an informal resolution decision within 45 calendar days from the receipt of the appeal. The Exchange shall notify the appellant in writing of the decision.
(d) If the appellant is satisfied with the outcome of the informal resolution decision, the appeal may be withdrawn. If the appeal is not withdrawn, it shall be automatically escalated to the second phase of the Appeals Process. During the second phase, an independent unit within the Exchange that had no involvement in the original eligibility or qualification determination or informal resolution decision shall review the eligibility or qualification of the appellant de novo. The appellant shall be allowed to present additional evidence during the second phase. The Exchange shall consider all relevant evidence presented during the course of the appeal and notify the appellant in writing of the final decision within 60 calendar days from the receipt of the appeal.
1. New section
filed 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A
Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency
language will be repealed by operation of law on the following day.
2.
Repealed by operation of Government Code section
11346.1(g)
(Register 2014, No. 7).
3. New section filed 2-10-2014 as an emergency
pursuant to Government Code section
11346.1,
subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of
Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be
repealed by operation of law on the following day.
4. New section refiled
5-12-2014 as an emergency pursuant to Government Code section
11346.1,
subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of
Compliance must be transmitted to OAL by 8-11-2014 or emergency language will be
repealed by operation of law on the following day.
5. New section refiled
7-21-2014 as an emergency pursuant to Government Code section
100504(a)(6),
as modified by Senate Bill 857 (Stats 2014, c. 31); operative 7-21-2014 (Register
2014, No. 30). A Certificate of Compliance must be transmitted to OAL by 7-15-2015
pursuant to Government Code section
100504 or
emergency language will be repealed by operation of law on the following
day.
6. 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 2-10-2017 or the language in the emergency order of
7-21-2014 will be repealed by operation of law on the following day (Register 2015,
No. 38).
7. Certificate of Compliance as to 7-21-2014 order, including
further amendment of subsection (a) and NOTE, transmitted to OAL 11-6-2015 and filed
12-23-2015 (Register 2015, No. 52).
Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 C.F.R. §§ 155.205 and 155.210.
