Section 2699.6403 - Administrative Review(a) Any appellant who files an appeal pursuant to Section 2699.6400 shall receive an initial administrative review of the appeal.(b) Administrative reviews of appeals shall be conducted in two steps. Each appeal will be reviewed by the program to determine if the requested resolution is required by the statutes and regulations governing the program, or required in order to be consistent with a written representation of program policy made by the program or the Board. If so, the appropriate action will be taken and the appellant will be notified. If not, the appellant will be so notified and informed that they may request review by the Executive Director. Such a request must be filed in writing with the Executive Director within 30 days of the date of the notice of the program determination, and shall include the information specified in Subsection 2699.6401(b).(c) In conducting an administrative review of an appeal, the Executive Director may contact the appellant and/or the participating health plan for further information.(d) The Executive Director's decision shall be in writing.(e) The appellant retains the right to request an administrative hearing if the appellant is not satisfied with the decision of the Executive Director. Such a request shall be filed within thirty (30) calendar days of receipt of the Executive Director's decision. It shall include a clear and concise statement of what action is being appealed, and the reason(s) the Executive Director's decision is not correct.Cal. Code Regs. Tit. 10, § 2699.6403
1. Renumbering of former section 2699.652 to section 2699.6403 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsection (e) filed 1-10-95 as an emergency; operative 1-10-95 (Register 95, No. 2). A Certificate of Compliance must be transmitted to OAL 5-10-95 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 1-10-95 order transmitted to OAL 4-25-95 and filed 6-7-95 (Register 95, No. 23).
4. Amendment of subsections (a) and (b) and amendment of NOTE filed 5-5-97; operative 7-1-97 (Register 97, No. 19). Note: Authority cited: Section 10731, Insurance Code. Reference: Sections 10731 and 10748, Insurance Code.
1. Renumbering of former section 2699.652 to section 2699.6403 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsection (e) filed 1-10-95 as an emergency; operative 1-10-95 (Register 95, No. 2). A Certificate of Compliance must be transmitted to OAL 5-10-95 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 1-10-95 order transmitted to OAL 4-25-95 and filed 6-7-95 (Register 95, No. 23).
4. Amendment of subsections (a) and (b) and amendment of Note filed 5-5-97; operative 7-1-97 (Register 97, No. 19).