Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1.
Eligibility.
A. MNsure appeals are available for the
following actions:
(1) initial determinations
and redeterminations made by MNsure of individual eligibility to purchase a
qualified health plan through MNsure, made in accordance with Code of Federal
Regulations, title 45, sections 155.305, (a) and (b); 155.330; and
155.335;
(2) initial determinations
and redeterminations made by MNsure of eligibility for and level of advance
payment of premium tax credit, and eligibility for and level of cost sharing
reductions, made in accordance with Code of Federal Regulations, title 45,
sections 155.305(f) to (g); 155.330; and 155.335;
(3) initial determinations and
redeterminations made by MNsure of employer eligibility to purchase coverage
for qualified employees through the Small Business Health Options Program under
Code of Federal Regulations, title 45, section 155.710(a);
(4) initial determinations and
redeterminations made by MNsure of employee eligibility to purchase coverage
through the Small Business Health Options Program under Code of Federal
Regulations, title 45, section 155.710(e);
(5) initial determinations and
redeterminations made by MNsure of individual eligibility for an exemption from
the individual responsibility requirement made in accordance with Code of
Federal Regulations, title 45, section 155.605;
(6) a failure by MNsure to provide timely
notice of an eligibility determination in accordance with Code of
Federal Regulations, title 45, sections 155.310(g); 155.330(e)(1)(ii);
155.335(h)(ii); 155.610(i); and 155.715 (e) and (f); and
(7) in response to a notice from MNsure under
Code of Federal Regulations, title 45, section 155.310(h), a
determination by MNsure that an employer does not provide minimum essential
coverage through an employer-sponsored plan or that the employer does provide
coverage but is not affordable coverage with respect to an employee.
(8) in response to a denial of a request to
vacate a dismissal made according to this chapter and in accordance with Code
of Federal Regulations, title 45, section 155.530(d)(2).
B. If an individual has been denied
eligibility for medical assistance under Code of Federal Regulations, title 45,
section 155.302(b), an appeal of a determination of eligibility for advanced
payments of the premium tax credit or cost-sharing reduction must also be
treated as an appeal of medical assistance determination of
eligibility.
Subp. 2.
Filing an appeal.
A. To initiate an
appeal, an appellant must file the appeal with MNsure as follows:
(1) by mail;
(2) by telephone;
(3) by Internet; or
(4) in person.
B. MNsure must provide the necessary contact
information for each method of filing an appeal with each written eligibility
determination and also through the MNsure Web site.
C. The agency must assist any potential
appellant in filing an appeal when assistance is requested.
D. An appeal must be received by MNsure
within 90 days from the date of the notice of eligibility determination. There
is a rebuttable presumption that the date of the notice of eligibility
determination is five business days later than the date printed on the notice.
The person may rebut this presumption by presenting evidence or testimony that
they received the notice five business days after the date printed on the
notice. An appeal received more than 90 days after the date of the eligibility
notice will be dismissed. If the deadline for filing an appeal falls on a day
that is not a business day, the filing deadline is the next business
day.
E. Appeal request forms will
be available to persons through the Internet, by in-person request, by mail,
and by telephone. The following information is requested, but not required, in
an appeal:
(1) name;
(2) MNsure username;
(3) date of birth;
(4) address, including either an e-mail
address, if available, or a mailing or physical address;
(5) MNsure programs involved in the appeal,
for which a list must be provided on the appeal request form;
(6) reason for the appeal; and
(7) in appeals of redeterminations of
eligibility, whether the appellant intends to continue at the level of
eligibility and benefits before the redetermination being appealed until the
appeal decision.
F.
Appeals shall be accepted regardless of whether the requested information is
provided on the form or the information is incomplete. However, failure by an
appellant to provide all of the requested information may prevent resolution of
the appeal or delivery of effective notice.
G. The date of official receipt of appeals
submitted after business hours, whether filed through the Internet or by
telephone, is the next business day.
Subp. 3.
Notices and communications.
A.
The parties to an appeal have the right to the following timely notices and
communications:
(1) acknowledgement of receipt
of the appeal and a scheduling order, including information regarding the
appellant's eligibility pending appeal and an explanation that any advance
payments of the premium tax credit paid on behalf of the tax filer pending
appeal are subject to reconciliation; and
(2) the decision and order of the MNsure
board.
B. Any notice
sent to the appellant must also be sent to the appellant's attorney or
representative.
C. An appeals
examiner shall not have ex parte contact on substantive issues with the agency,
the appellant, or any person involved in an appeal. No agency employee shall
review, interfere with, change, or attempt to influence the recommended
decision of the appeals examiner in any appeal, except through the procedures
allowed herein. The limitations in this subpart do not affect the board's
authority to review or make final decisions.
Subp. 4.
Rescheduling.
A. Requests to reschedule a hearing must be
made in person, by telephone, through the Internet, or by mail to the appeals
examiner . The rescheduling request may be made orally or in writing. The
requesting party must provide the other party a copy of a written request or
must otherwise notify the other party of the request if the request is made
orally.
B. Requests to reschedule a
hearing with less than five calendar days' advance notice of the scheduled
hearing date requires one attempt by the requesting party to contact the other
party to notify them of the forthcoming request and to provide an opportunity
to express disagreement, if any. Requests to reschedule a hearing with less
than 24 hours' advance notice of the scheduled hearing date is at the
discretion of the appeals examiner upon considering the potential prejudicial
effect or burden to the appellant.
C. Unless a determination is formally made in
writing by the appeals examiner that a request to reschedule a hearing is made
for the purpose of delay or where a party has expressed disagreement, as
provided for in item B, and the reason for the disagreement outweighs the need
for the rescheduling, a hearing must be rescheduled by the appeals examiner for
good cause as determined by the appeals examiner. Good cause includes the
following:
(1) to accommodate a
witness;
(2) to obtain necessary
evidence, preparation, or representation;
(3) to review, evaluate, and respond to new
evidence;
(4) to permit
negotiations of resolution between the parties;
(5) to permit the agency to
reconsider;
(6) to permit actions
not previously taken;
(7) to
accommodate a conflict of previously scheduled appointments;
(8) to accommodate a physical or mental
illness;
(9) where an interpreter,
translator, or other service necessary to accommodate a person with a
disability is needed but not available; or
(10) any other compelling reasons beyond the
control of the party that prevents attendance at the originally scheduled
time.
D. If requested by
the appeals examiner, a written statement confirming the reasons for the
rescheduling request must be provided to the appeals examiner by the requesting
party.
Subp. 4a.
Resolution offers.
The agency, in its discretion, may offer the appellant
consideration to compromise or resolve the appeal. If such an offer is made,
the appellant must communicate to MNsure the appellant's acceptance or denial,
including plan enrollment selection, where applicable, within 14 calendar days
from the day the offer is made or the offer expires.
Subp. 5.
Telephone, videoconference, or in-person hearing.
A. A hearing may be conducted by telephone,
videoconference, or in person. An in-person appeals hearing will only be held
at the discretion of the appeals examiner, or if the person asserts that either
the person or a witness has a physical or mental disability that would impair
the person's ability to fully participate in a hearing held by interactive
video technology. To have the hearing conducted by videoconference or in
person, a person must make a specific request for that type of
hearing.
B. When an in-person
hearing is granted, the appeals examiner shall conduct the hearing in the
county where the person involved resides, unless an alternate location is
mutually agreed upon before the hearing.
C. Where federal law or regulation does not
require a telephone, videoconference, or in-person hearing and allows for a
review of documentary evidence through a desk review, a telephone,
videoconference, or in-person hearing will only be provided when the appeals
examiner determines that such a hearing would materially assist in resolving
the issues presented by the appeal.
Subp. 6.
Emergency expedited appeals.
A. An appellant has a
right to an emergency expedited appeal when there is an immediate need for
health services because a standard appeal could seriously jeopardize the
appellant's life or health or ability to attain, maintain, or regain maximum
function. An appellant must specify that an emergency expedited appeal is being
requested when submitting the initial appeal. If an emergency develops during a
pending appeal such that there has developed an immediate need for health
services because a standard appeal could seriously jeopardize the appellant's
life or health or ability to attain, maintain, or regain maximum function, an
appellant may request an expedited appeal.
B. An appeals examiner must grant an
emergency expedited appeal if an appellant has any of the following conditions
or circumstances:
(1) pregnancy and
postpartum care;
(2) newborn
baby;
(3) prescriptions for chronic
illnesses;
(4) dialysis;
(5) cancer treatment;
(6) broken bones needing immediate
treatment;
(7) prescription refills
necessitating physician visit;
(8)
outpatient treatment currently being received;
(9) prescriptions for mental health
conditions;
(10) nonelective
surgery;
(11) heart
disease;
(12) severe mood and brain
disorders (e.g., schizophrenia, bipolar disorder); or
(13) other similar conditions or
circumstances.
C. If a
request for an expedited appeal is denied, the appellant will be notified
according to the process and time period required under the applicable federal
law.
D. If a request for an
expedited appeal is accepted, the appeals examiner will issue a decision
according to the process and time period required under the applicable federal
law.
Subp. 7.
Interpreter and translation services.
A. Appeals must be accessible to appellants
who have limited English proficiency, appellants who require interpreter and
translation services, and appellants with disabilities. An appeals examiner has
a duty to inquire whether any person involved in the hearing needs the services
of an interpreter, translator, or reasonable accommodations to accommodate a
disability in order to participate in or to understand the appeal
process.
B. Necessary interpreter
services, translation services, or reasonable accommodations must be provided
at no cost to the person involved in the appeal.
C. If an appellant requests interpreter
services, translation services, or reasonable accommodations or it appears to
the appeals examiner that necessary interpreter or translation services are
needed but not available for the scheduled hearing, the hearing shall be
rescheduled to the next available date when the appropriate services can be
provided.
Subp. 8.
Access to data.
A. Subject to the
requirements of all applicable state and federal laws regarding privacy,
confidentiality, and disclosure of personally identifiable information, the
appellants and agencies involved in an appeals hearing must be allowed to
access the appeal record upon request at a convenient place and time before and
during the appeals hearing. Upon request, copies of the appeal record,
including an electronic copy of the recorded hearing, must be provided at no
cost and, upon request, must be mailed or sent by electronic transmission to
the party or the party's representative.
B. An appellant involved in an appeals
hearing may enforce the right of access to data and copies of the case file by
making a request to the appeals examiner. The appeals examiner shall make an
appropriate order enforcing the appellant's right of access, including but not
limited to ordering access to files, data, and documents possessed by the
agency; continuing or rescheduling an appeal hearing to allow adequate time for
access to data; or prohibiting use by the agency of files, data, or documents
that have been generated, collected, stored, or disseminated in violation of
the requirements of state or federal law, or when the documents have not been
provided to the appellant involved in the appeal.
Subp. 9.
Data practices.
A. Data on
individuals, as defined in Minnesota Statutes, section
13.02, subdivision 5, will be
collected about persons and appellants throughout the appeals process. The
purpose of this data collection is to conduct an appeal. A party to an appeal
is not required to supply data for an appeal. However, deciding which evidence
and testimony to submit may have an impact on the outcome of the appeal
decision. Certain other government officials may have access to information
provided throughout the appeals process if this is allowed by law or pursuant
to a valid court order.
B. When an
appeal proceeds beyond the MNsure appeals process to judicial review, the
appeal record will be public unless the court with jurisdiction over the appeal
issues a protective order. When the appeal proceeds outside of the MNsure
appeals process to the United States Department of Health and Human Services,
the record will be classified according to federal law governing the collection
of data on individuals.
Subp. 10.
Appeal summary.
The agency must prepare an appeal summary for each appeal
hearing. The appeal summary shall be delivered to each party and the MNsure
appeals examiner at least three business days before the date of the appeal
hearing. The appeals examiner shall confirm that the appeal summary is
delivered to the party involved in the appeal as required under this subpart.
Each party shall be provided, through the appeal summary or other reasonable
methods, appropriate information about the procedures for the appeal hearing
and an adequate opportunity to prepare. The contents of the appeal summary must
be adequate to inform each party of the evidence on which the agency relies and
the legal basis for the agency's action or determination.
Subp. 11.
Representation during appeal.
An appellant may personally appear in any appeal hearing and
may be represented by an attorney or representative. A partnership may be
represented by any of its members, an attorney, or other representative. A
corporation or association may be represented by an officer, an attorney, or
other representative. In a case involving an unrepresented appellant, the
appeals examiner shall examine witnesses and receive exhibits for the purpose
of identifying and developing in the appeal record relevant facts necessary for
making an informed and fair decision. An unrepresented appellant shall be
provided an adequate opportunity to respond to testimony or other evidence
presented by the agency at the appeal hearing. The appeals examiner shall
ensure that an unrepresented appellant has a full and reasonable opportunity at
the appeal hearing to establish a record for appeal. An agency may be
represented by an employee or an attorney, including an attorney employed by
the agency as authorized by law.
Subp. 12.
Dismissals.
A. The appeals
examiner must dismiss an appeal if the appellant:
(1) withdraws the appeal orally or in
writing;
(2) fails to appear at a
scheduled appeal hearing or prehearing conference and good cause is not
shown;
(3) fails to submit a valid
appeal; or
(4) dies while the
appeal is pending.
B. If
an appeal is dismissed, the appeals examiner must provide timely notice to the
parties, which must include the reason for dismissal, an explanation of the
dismissal's effect on the appellant's eligibility, and an explanation of how
the appellant may show good cause why the dismissal should be
vacated.
C. The appeals examiner
must vacate a dismissal if the appellant makes a written request within 30 days
of the date of the notice of dismissal showing good cause why the dismissal
should be vacated. There is a rebuttable presumption that the date of the
notice of dismissal is five business days later than the date printed on the
notice. The person may rebut this presumption by presenting evidence or
testimony that they received the notice later than five business days after the
date printed on the notice. Good cause can be shown when there is:
(1) a death or serious illness in the
person's family;
(2) a personal
injury or physical or mental illness that reasonably prevents an appellant or
witness from attending the hearing;
(3) an emergency, crisis, including a mental
health crisis, or unforeseen event that reasonably prevents an appellant or
witness from attending the hearing;
(4) an obligation or responsibility of an
appellant or witness which a reasonable person, in the conduct of one's
affairs, could reasonably determine takes precedence over attending the
hearing;
(5) lack of or failure to
receive timely notice of the hearing in the preferred language of an appellant
involved in the hearing;
(6)
excusable neglect, excusable inadvertence, or excusable mistake as determined
by the appeals examiner; or
(7) any
other compelling reason beyond the control of the party as determined by the
appeals examiner.
Subp. 13.
Prehearing conferences.
A. The
appeals examiner, at the examiner's discretion, prior to an appeal hearing may
hold a prehearing conference to further the interests of justice or efficiency.
The parties must participate in any prehearing conference held. A party may
request a prehearing conference. The prehearing conference may be conducted by
telephone, in writing, or in person. The prehearing conference may address the
following issues:
(1) disputes regarding
access to files, evidence, subpoenas, or testimony;
(2) the time required for the hearing or any
need for expedited procedures or decision;
(3) identification or clarification of legal
or other issues that may arise at the hearing;
(4) identification of and possible agreement
to factual issues; and
(5)
scheduling and any other matter that will aid in the proper and fair
functioning of the hearing.
B. The appeals examiner shall make a record
or otherwise contemporaneously summarize the prehearing conference in writing,
which shall be sent to:
(1) the parties;
and
(2) the party's attorney or
representative.
Subp. 14.
Disqualification of appeals examiner.
A. The chief appeals
examiner shall remove an appeals examiner from any case where the appeals
examiner believes that presiding over the case would create the appearance of
unfairness or impropriety. No appeals examiner may hear any case where any of
the parties to the appeal are related to the appeals examiner by blood or
marriage. An appeals examiner must not hear any case if the appeals examiner
has a financial or personal interest in the outcome. An appeals examiner having
knowledge of such a relationship or interest must immediately notify the chief
appeals examiner and be removed from the case.
B. A party may move for the removal of an
appeals examiner by written application of the party together with a statement
of the basis for removal. Upon the motion of the party, the chief appeals
examiner must decide whether the appeals examiner may hear the particular case.
Removal of an appeals examiner under this item is at the discretion of the
chief appeals examiner.
Subp. 15.
Status of eligibility and benefits pending appeal.
A. In appeals involving a redetermination of
an appellant's eligibility, the appellant shall continue at the level of
eligibility and benefits before the redetermination being appealed only if the
appellant affirmatively elects to receive them during the appeal.
B. The appeal type, as specified in subpart
1, item A, determines what
eligibility and benefits are available to be continued pending appeal. The
availability of a continuation of eligibility and benefits is only available
for appellants under subpart
1, item A, subitems (1) and
(2). If appealing eligibility for advanced payments of premium tax credits
and/or cost-sharing reductions, at issue is the amount of the advance payments
of premium tax credits and/or cost-sharing reductions; and if appealing the
eligibility to purchase a QHP through MNsure, at issue is the eligibility to
purchase a QHP through MNsure.
C.
Where an appellant continues at the level of eligibility before the
redetermination being appealed and the appeal decision upholds the
redetermination being appealed, the appellant is subject to reconciliation and
repayment of any overpayment.
Subp. 16.
Commencement and conduct of hearing.
A. The appeals
examiner shall begin each hearing by describing the process to be followed in
the hearing, including the swearing in of witnesses, how testimony and evidence
are presented, the order of examining and cross-examining witnesses, and the
opportunity for an opening statement and a closing statement. The appeals
examiner shall identify for the parties the issues to be addressed at the
hearing and shall explain to the parties the burden of proof that applies to
the appellant and the agency. The appeals examiner shall confirm, prior to
proceeding with the hearing, that the appeal summary, if prepared, has been
properly completed and provided to the parties, and that the parties have been
provided documents and an opportunity to review the appeal record, as provided
in this part.
B. The appeals
examiner shall act in a fair and impartial manner at all times. At the
beginning of the appeal hearing, the agency must designate one person as a
representative who shall be responsible for presenting the agency's evidence
and questioning any witnesses. The appeals examiner shall make sure that both
the agency and the appellant are provided sufficient time to present testimony
and evidence, to confront and cross-examine all adverse witnesses, and to make
any relevant statement at the hearing. All testimony in the hearing will be
taken under oath or affirmation. The appeals examiner shall make reasonable
efforts to explain the appeal hearing process to unrepresented appellants and
shall ensure that the hearing is conducted fairly and efficiently. Upon the
reasonable request of the appellant or the agency or at the discretion of the
appeals examiner, the appeals examiner shall direct witnesses to remain outside
the hearing room, except during individual testimony, when the appeals examiner
determines that such action is appropriate to ensure a fair and impartial
hearing. The appeals examiner shall not terminate the hearing before affording
the appellant and the agency a complete opportunity to submit all admissible
evidence and reasonable opportunity for oral or written statement. In the event
that an appeal hearing extends beyond the time allotted, the appeal hearing
shall be continued from day to day until completion. Appeal hearings that have
been continued shall be timely scheduled to minimize delay in the disposition
of the appeal.
C. The appeal
hearing shall be a de novo review and shall address the correctness and
legality of the agency's action and shall not be limited simply to a review of
the propriety of the agency's action. The appellant may raise and present
evidence on all legal claims or defenses arising under state or federal law as
a basis for the appeal, excluding any constitutional claims that are beyond the
jurisdiction of the appeal hearing. The appeals examiner may take official
notice of adjudicative facts.
D.
The burden of persuasion is governed by specific state or federal law and
regulations that apply to the subject of the hearing. Unless otherwise required
by specific state or federal laws that apply to the subject of the appeal, the
appellant carries the burden to persuade the appeals examiner that a claim is
true and must demonstrate such by a preponderance of the evidence.
E. The appeals examiner shall accept all
evidence, except evidence privileged by law, that is commonly accepted by
reasonable people in the conduct of their affairs as having probative value on
the issues to be addressed at the appeal hearing. The appeals examiner shall
ensure for all cases that the appeal record is sufficiently complete to make a
fair and accurate decision.
F. The
agency must present its evidence prior to or at the appeal hearing. The parties
shall not be permitted to submit evidence after the hearing except:
(1) by agreement at the hearing between the
appellant, the agency, and the appeals examiner;
(2) in response to new evidence; or
(3) when determined necessary by the appeals
examiner to receive evidence needed to sufficiently complete the appeal record
and make a fair and accurate decision.
If a party submits evidence after the appeal hearing, the
other party must be allowed sufficient opportunity to respond to the evidence.
Subp. 17.
Orders of the MNsure board.
A. A timely, written
decision must be issued in every appeal. Each decision must contain a clear
ruling on the issues presented in the appeal hearing and contain a ruling only
on questions directly presented by the appeal and the arguments raised in the
appeal.
B. A written decision must
be issued within 90 days of the date the appeal is received, as
administratively feasible, unless a shorter time is required by law.
C. The decision must contain both findings of
fact and conclusions of law, clearly separated and identified. The findings of
fact must be based on the entire appeal record. Each finding of fact made by
the appeals examiner shall be supported by a preponderance of the evidence
unless a different standard is required by law. The legal claims or arguments
of a participant do not constitute either a finding of fact or a conclusion of
law, except to the extent the appeals examiner explicitly adopts an argument as
a finding of fact or conclusion of law.
D. The decision shall contain at least the
following:
(1) a listing of the date and place
of the appeal hearing and the parties and persons appearing at the appeal
hearing;
(2) a clear and precise
statement of the issues, including the dispute that is the subject of the
appeal and the specific points that must be resolved in order to decide the
case;
(3) a listing of each of the
materials constituting the appeal record that were placed into evidence at the
appeal hearing, and upon which the appeal hearing decision is based;
(4) the findings of fact based upon the
entire appeal record. The findings of fact must be adequate to inform the
parties and the public of the basis of the decision. If the evidence is in
conflict on an issue that must be resolved, the findings of fact must state the
reasoning used in resolving the conflict;
(5) conclusions of law that address the legal
authority for the appeal hearing and the ruling, and which give appropriate
attention to the claims of the parties;
(6) a clear and precise statement of the
decision made resolving the dispute that is the subject of the appeal,
including the effective date of the decision; and
(7) written notice of any existing right to
appeal, including taking an appeal to the United States Department of Health
and Human Services and identifying the time frame for an appeal and that the
decision is final unless appealed.
E. The appeals examiner shall not
independently investigate facts or otherwise rely on information not presented
at the appeal hearing. However, if the appeals examiner needs further
clarification from the parties, the appeals examiner may request clarification
from the parties at any time until a decision is issued. The appeals examiner
may not contact other agency personnel, except as provided in subpart
16. The appeals examiner's
recommended decision must be based exclusively on the testimony and evidence
made part of the appeals record, legal arguments presented, and the appeals
examiner's research and knowledge of the law.
F. The MNsure board shall review the
recommended decision and accept or refuse to accept the decision. The MNsure
board may accept the recommended order of an appeals examiner and issue the
order to the parties or may refuse to accept the decision. Upon refusal, the
MNsure board shall notify the parties of the refusal, state the reasons, and
allow each party ten days to submit additional written argument on the matter.
After the expiration of the ten-day period, the MNsure board shall issue an
order on the matter to the parties. Refusal of the MNsure board to accept a
decision must not delay the 90-day time limit to issue a decision.
G. Orders of the MNsure board shall be
implemented either:
(1) prospectively on the
first day of the month following the notice of appeal decision; or
(2) retroactively to the date ordered by the
appeals examiner, at the option of the appellant.
An appellant shall communicate to the agency the appellant's
plan enrollment selection within 60 calendar days from the notice of the appeal
decision or the enrollment opportunity expires.
Subp. 18.
Public access to hearings and decisions.
Appeal decisions must be maintained in a manner so that the
public has ready access to previous decisions on particular topics, subject to
appropriate procedures for compliance with applicable state and federal laws
regarding the privacy, confidentiality, and disclosure, of personally
identifiable information. Appeal hearings conducted under this part are not
open to the public due to the not public classification of the information
provided for inclusion in the appeal record.
Subp. 18a.
Reconsideration.
A. A party aggrieved by an order of the
MNsure board may appeal under subpart
19 or
20, as applicable, or
request reconsideration by the MNsure board within 30 days after the date the
MNsure board issues the order. The MNsure board may reconsider an order upon
request of any party or on the MNsure board's own motion. A request for
reconsideration does not stay implementation of the MNsure board's order. The
party seeking reconsideration has the burden to demonstrate why the matter
should be reconsidered. The request for reconsideration may include legal
argument and proposed additional evidence supporting the request, but this
information is not required. If proposed additional evidence is submitted, the
party must explain why the proposed additional evidence was not provided at the
time of the hearing. If reconsideration is granted, the other parties must be
sent a copy of all material submitted in support of the request for
reconsideration and must be given ten days to respond. Upon reconsideration,
the MNsure board may issue an amended order or an order affirming the original
order.
B. Any order of the MNsure
board issued under this subpart shall be final upon the parties unless an
appeal is made in the manner provided under subpart
19 or
20, as applicable. Any order
of the MNsure board is binding on the parties and must be implemented until the
order is reversed.
C. A vendor,
contractor, health insurance carrier, or other MNsure stakeholder is not a
party and may not request a hearing or seek judicial review of an order issued
under this part unless the vendor, contractor, health insurance carrier, or
other MNsure stakeholder is assisting an appellant as a
representative.
Subp. 19.
Administrative review.
A.
Administrative review by the United States Department of Health and Human
Services may be available for parties aggrieved by an order of the MNsure
board.
B. An appeal under this part
must be filed with the United States Department of Health and Human Services
and MNsure within 30 days of the date of the appeal decision according to the
process required under the applicable federal regulations.
Subp. 20.
Judicial review.
An appellant may seek judicial review to the extent it is
available under Minnesota Statutes, section
62V.05, subdivision 6,
paragraphs (e) to (i), or as otherwise allowed by law.
Statutory Authority:
L
2013 c 9
s
14;
62V.08