HAR §17-1703.1-4. Action on request for hearing

(a) An individual shall submit a hearing request: (1) By telephone; (2) Via mail; (3) In person; or (4) Through other commonly available electronic means. (b) The Med-QUEST Division must receive a hearing request within ninety (90) calendar days of the date of the notice for: (1) Eligibility related decisions; (2) Fee-for-service program coverage decisions; and (3) Managed care health plan coverage decisions after completion of the managed care health plan’s grievance and appeals process. If the ninetieth (90th) day falls on a weekend or holiday, the ninetieth day shall then be the first working day following the weekend or holiday. (c) Upon receipt by the hearing office, the request shall be date stamped and immediately forwarded to the Med-QUEST Division to: (1) Determine whether the request was received within the period specified in this section; (2) Enter the individual’s name, case number, and date received; (3) Verify the authority of a court appointed guardian filing on behalf of an individual through appropriate court documents. (d) If the hearing request was not filed within ninety (90) calendar days of the date the notice was sent to the individual as UNOFFICIAL 1703.1-4 described in (b), the request shall be denied and the department shall send a notice of denial to the individual. (e) If an individual denied eligibility for Medicaid by the department files an appeal with the Health Insurance Exchange that appeal shall be treated as a request for hearing under this section. (f) When the requirements specified in section 17-1703.1-5 are met, the department shall reinstate or continue assistance. [Eff 09/30/13] (Auth: HRS §346-14(9); 42 C.F.R. §§431.221, 431.230, 431.231) (Imp: HRS §346-12; 42 C.F.R. §§431.221, 431.230, 431.231) §17-1703.1-5 Payment status of medical assistance or coverage pending hearing. (a) The beneficiary is entitled to timely notice as to the status of medical assistance or coverage pending hearing. (b) Adequate notice that medical assistance shall be reinstated and continued shall be provided where: (1) Pertaining to eligibility or the fee-for- service program coverage denial, the beneficiary requests a hearing within fifteen (15) calendar days of the date of the adequate notice for adverse action. (2) Pertaining to a managed care health plan’s coverage denial, the beneficiary requests a hearing from the department within ten (10) calendar days of the date of the managed care health plan’s notice for adverse action, for continuation of benefits, which were ordered by an authorized provider, and the original period covered by the original authorization has not expired. (3) If the fifteenth (15th) day or tenth (10th) day as applicable falls on a weekend or holiday, the fifteenth (15th) day or tenth (10th) day as applicable shall be the first working day following the weekend or holiday. (4) If the last day of the month falls on a weekend or holiday, the last day shall be the first working day following the weekend or holiday. (c) The medical assistance or coverage UNOFFICIAL 1703.1-5 reinstated under (b) shall continue until a hearing decision is rendered unless: (1) The beneficiary withdraws or abandons the request for hearing as specified in section 17-1703.1-9; (2) Action was due to the application or a change in state or federal law or policy; (3) Another change affecting the beneficiary’s eligibility occurs during the hearing process and the beneficiary fails to request a hearing after notice of the change; (4) The beneficiary does not request continued benefits pending a hearing decision. (5) In the case of a managed care health plan appeal, the time period or service limits of a previously authorized service has been met. (d) The department shall promptly send a notice to the beneficiary if benefits are to be reduced or discontinued pending the hearing decision for reasons other than withdrawal or abandonment of the request by the beneficiary. (e) If, while receiving aid paid pending hearing, the beneficiary: (1) Becomes eligible for a reduction of spenddown amount, or premium-share amount, the change shall be made; or (2) Sends a written request for and is denied a medical service, aid paid pending shall continue and a notice of the denial shall be sent to the beneficiary. The notice shall include a statement of the denial, reason for the denial, specific rule supporting the denial, and the person's right to appeal the decision. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §§431.223, 431.223, 431.230, 431.231, 431,250) (Imp: HRS §346- 12; 42 C.F.R. §§431.223, 431.223, 431.230, 431.231, 431,250)