Access to fair hearings
NE | NY | PA | WA"7.33 Client Rights: The Contractor shall provide written notice to the client of any adverse reaction (i.e., denial or reduction) regarding the provision of services that complies with all federal and state requirements. The Contractor shall also allow clients to challenge decisions to deny, limit or terminate coverage of services. Clients shall be allowed to file complaints, grievances and appeals pursuant to this contract...
11.4.6 Fair Hearings: The client has a right to appeal under 465NAC. Hearings are scheduled and conducted according to the procedures outlined in 465 NAC pursuant to Addendum E (Pertinent Regulations)." Nebraska Contract, pages 74, 118.
"C. An Enrollee whose request for disenrollment is denied by the LDSS must
be advised that he/she may file a request for a fair hearing...15 .2 Nothing in this Agreement shall limit or in any way jeopardize a Medicaid recipient's rights under the State Fair Hearing Regulations specified in 18 NYCRR, Part 358 and the requirements set forth in Chapter 23 of New York State's 1115 Waiver Operational Protocol for the Fair Hearing Process. Enrollees may access the Fair Heating Process in accordance with federal requirements, regulations, and policies as could any other Medicaid beneficiary. Contractors must abide by New York State's Fair Hearing process." New York Contract, pages 21, 37.
"Grievance and Appeals
The contractor must develop and implement a plan to: ...
2. Inform the recipient/provider of the right to file for a fair hearing appeal with the Department's Bureau of Hearings and Appeals according to PA 55 Section 275." Pennsylvania Program Standards, Rider 2."The Clinic agrees to:
A. Provide the following PCCM services to its enrollees using Primary Care providers (PCP) including physicians, physicians assistants (PA), and/or advanced registered nurse practitioners (ARNP): ...
4) Provide enrollees with information about the Department's fair hearing process whenever the Clinic denies authorization of a service." Washington State Healthy Options, pages 1-2.