Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 403 - MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES (HCBS) FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES
Chapter 2 - APPLICATION, ELIGIBILITY, FUNDING, REGISTRY, AND APPEALS
Section 403-2-009 - FAIR HEARING PROCESSES

Universal Citation: 403 NE Admin Rules and Regs ch 2 ยง 009

Current through September 17, 2024

009.01 RIGHT TO APPEAL. An applicant or participant has the right to appeal the following actions and inactions:

(A) The denial of an application;

(B) The failure of the Department to act on an application with reasonable promptness;

(C) A change in the amount or type of benefits or services;

(D) A determination of the amount of medical expenses that must be incurred to establish eligibility;

(E) A determination of the amount of premiums and cost sharing charges;

(F) A determination that the level of services provided by an Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) is not required;

(G) A determination that services are not required;

(H) The form of payment or services is changed to be more restrictive; or

(I) The denial of a claim for benefits or services.

009.02. AUTOMATIC CHANGES. An applicant or participant is not entitled to appeal when state or federal law requires automatic changes adversely affecting some or all classes of applicants or participants.

009.03 REQUEST A FAIR HEARING. An applicant or participant can appeal to the Director for a hearing on any action or inaction with regard to an application, the amount of the assistance payment or failure to act with reasonable promptness. An appeal must be filed in writing within 90 days of the action or inaction. If an appeal is submitted within 10 days of a Notice of Decision being mailed, it is assumed that the applicant or participant is requesting that any ongoing assistance that is the subject of the appeal will continue during the pendency of the appeal, unless the applicant or participant indicates a contrary intent.

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