Current through Bulletin 2024-18, September 15, 2024
(1) A person has the right to:
(a) receive adequate notice of agency action
in writing; and
(b) present a
grievance about an agency action by requesting an administrative
hearing.
(2) The division
shall notify a person in writing at least ten days before taking an agency
action, including a change in funding, eligibility, or service; except if the
person signs a written statement acknowledging consent to the agency action,
the division shall send notice no later than the date of action.
(a) Notice of agency action that affects a
non-waiver service shall include the information required by Sections
63G-4-201
and
R497-100-5.
(b) Notice of agency action that affects a
waiver service shall include the information required by
42 CFR 431.210;
and Sections
63G-4-201,
R497-100-5,
and
R410-14-3.
(c) To assist a person with an administrative
hearing request, the division shall send the person a Hearing Request Form 490S
when the division sends the Notice of Agency Action Form 522.
(3) A person receiving a
non-waiver service may request an informal administrative hearing as described
in Rule R497-100.
(a) An administrative
hearing must be requested within 30 days of the mailing date shown on the
Notice of Agency Action Form 522.
(b) The person must file a Hearing Request
Form 490S with the division to request a hearing with the Department of Human
Services Office of Administrative Hearings.
(c) If the person files a hearing request
before the date of action written on the Notice of Agency Action Form 522, the
person's service or benefit shall continue unchanged during the administrative
hearing process.
(4) A
person receiving a waiver service may request an informal administrative
hearing as described in Rule R497-100 or Section
R410-14-24.
(a) An administrative hearing must be
requested within 30 days of the mailing date shown on the Notice of Agency
Action Form 522.
(b) The person
must file the request as described in Section
R410-14-5 to
request a hearing with the Department of Health Division of Medicaid and Health
Financing.
(c) The person must file
a Hearing Request Form 490S with the division to request a hearing with the
Department of Human Services Administrative Hearings Office.
(d) If the person files a hearing request
before the date of action written on the Notice of Agency Action Form 522, the
person's service or benefit shall continue unchanged during the administrative
hearing process.
(5) To
dispute implementation of a service by a provider, a person receiving a service
may request an informal administrative hearing as described in Rule
R497-100.
(6) A person may request
an informal administrative hearing and choose to participate in the division's
dispute resolution process before the administrative hearing.
(a) If the person chooses to participate in
the division's dispute resolution process, the 30-day deadline to request an
administrative hearing as described in Subsections R539-3-8(3) and R539-3-8(4)
applies.
(b) If the person requests
a hearing and chooses the division dispute resolution process, the person must
complete the dispute resolution process before the administrative hearing
begins. The person must submit a written request to the division to end the
dispute resolution process before reaching a resolution.
(c) The division's dispute resolution process
is not an adjudicative proceeding as described in Section
63G-4-201.
