Appeals 510-03-25-30

(New 7/1/2014 ML #3404)

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IM 5344

 

 

(N.D.A.C. Chapter 75-01-03)

 

1. Applicants or recipients of Medicaid who are dissatisfied with a decision made by the county agency or the North Dakota Department of Human Services, or who have not had their application acted on with reasonable promptness, may appeal to the North Dakota Department of Human Services.

2. A request to appeal must be in writing and not later than 30 days from the date the notice of action is mailed. When an applicant or recipient requests a hearing without completing the SFN 162, Request for Hearing, the county must complete an SFN 162, Request for Hearing, based on the information available. When the county is completing the SFN 162, the form is not signed by the county.

3. When a recipient requests an appeal prior to the effective date of an adverse decision, the recipient's Medicaid eligibility may not be reduced or terminated until a decision is rendered after the appeal hearing unless it is determined that the sole issue is one of Federal or state law or policy. In these cases, the recipient must be informed in writing that eligibility will be reduced or terminated pending the final appeal decision. This applies even when a review of eligibility is due before the final appeal decision is made.

4. When assistance has continued pending an appeal decision and the county agency's decision to close the case or reduce benefits is upheld, the case must be closed, or the benefits reduced, immediately upon receipt of the notice of decision. Pursue collection of any Medicaid benefits paid during the period assistance was continued pending the appeal decision.

5. Refer to Service Chapter 448-01-30 for more information with regard to Hearings and Appeals.