Times and Methods for Filing Appeal Requests

(1) The Applicant, Eligible Individual, Enrollee, or Employer will receive a notice in writing of an Appealable Action identified in 956 CMR 12.13 from either MassHealth or the Connector or both. That notice will also include notice of the right to an appeal, including to a hearing with an independent hearing officer, of the method by which an appeal may be requested, and of the right to use an Appeal Representative. The notice will also include a form for appealing the action. (2) The request for an appeal must be received within the following time limits: (a) For any Appealable Action regarding a Connector Program for Non-group Health plans 1. 30 days after the receipt of the notice of the Appealable Action. (In the absence of evidence to the contrary, it will be presumed that the notice was received five days after the date on the notice); or 2. 120 days from the date of an Appealable Action if the Connector fails to send written notice of such action or fails to act on a request for an eligibility determination. (b) For any Appealable Action regarding a Connector Program for Small Group Health plans, 90 days after receipt of the notice of the Appealable Action or from the date of an Appealable Action if the Connector fails to send written notice of such action or fails to act on a request for an eligibility determination. (In the absence of evidence to the contrary, it will be presumed that the notice was received five days after the date on the notice.) (3) The time periods in 956 CMR 12.14(2) will expire on the last day of such periods, unless the day falls on a Saturday, Sunday, or legal holiday, in which event the last day of the time period will be deemed to be the following business day. (4) Upon request by an Applicant, Eligible Individual, Enrollee, or Employer, the Connector will provide a form to request an appeal. The Connector and or its agent/designee may not restrict an individual's or an Employer's freedom to request an appeal.