Departmental Appeals Board - Appeals Council - The Fourth Level of

340 - Departmental Appeals Board - Appeals Council - The Fourth Level of Appeal (Rev. 4278., Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19) The level of administrative review available to parties after the ALJ hearing decision, OMHA attorney adjudicator review, or dismissal order has been issued, but before judicial review is available, is Appeals Council review. A party to an ALJ hearing or an OMHA attorney adjudicator review, may request review by the Appeals Council within 60 days after receipt of the notice of OMHA’s decision or dismissal. If a party requests the Appeals Council to review an ALJ’s or attorney adjudicator’s decision, the Appeals Council may conduct a de novo review of the decision and may adopt, modify, or reverse the ALJ’s or attorney adjudicator’s decision, or remand the case to an ALJ or attorney adjudicator for further proceedings. See, in general 42 CFR 405.1108. The Appeals Council will dismiss a request for review when a party does not have a right to Appeals Council review. When a party requests that the Appeals Council review an ALJ’s or attorney adjudicator's dismissal, the Appeals Council may deny review or remand the case to an ALJ or attorney adjudicator for further proceedings. The Appeals Council may also dismiss a request for a hearing for any reason the ALJ or attorney adjudicator could have dismissed the request for hearing. In addition, the Appeals Council will decide cases that are escalated from the OMHA level without an ALJ or attorney adjudicator decision or dismissal. See 42 CFR 405.1108(d). The Appeals Council may also decide on its own motion to review a decision or dismissal issued by an ALJ or attorney adjudicator within 60 days after the date of the decision or dismissal.