Section 1850.207 - The Appeal ProcessIn addition to meeting the requirements of Section 1850.205, the appeal process shall, at a minimum:
(a) Allow a beneficiary to file an appeal orally or in writing.(b) Require a beneficiary to follow an oral appeal with a written appeal. The date the MHP receives the oral appeal shall be considered the filing date for the purpose of applying the appeal timeframes in Subsection (c).(c) Provide for a decision on the appeal and notify the affected parties within 45 calendar days of receipt of the appeal. This timeframe may be extended by up to 14 calendar days, if the beneficiary requests an extension or the MHP determines that there is a need for additional information and that the delay is in the beneficiary's interest. If the MHP extends the timeframes, the MHP shall, for any extension not requested by the beneficiary, notify the beneficiary of the extension and the reasons for the extension in writing. The written notice of the extension is not a Notice of Action as defined in Section 1810.230.5.(d) Inform the beneficiary of his or her right to request a fair hearing after the appeal process of the MHP has been exhausted.(e) Allow the beneficiary to have a reasonable opportunity to present evidence and allegations of fact or law, in person or in writing.(f) Allow the beneficiary and/or his or her representative to examine the beneficiary's case file, including medical records, and any other documents or records considered before and during the appeal process.(g) Allow the beneficiary and/or his or her representative, or the legal representative of a deceased beneficiary's estate to be included as parties to the appeal.(h) Notify the beneficiary and/or his or her representative of the resolution of the appeal in writing. The notice shall contain:(1) The results of the appeal resolution process.(2) The date that the appeal decision was made.(3) If the appeal is not resolved wholly in favor of the beneficiary, the notice shall also contain information regarding the beneficiary's right to a fair hearing and the procedure for filing for a fair hearing, if the beneficiary has not already requested a fair hearing on the issue involved in the appeal.(i) Promptly provide or arrange and pay for the disputed services if the decision of the appeal resolution process reverses a decision to deny, limit or delay services.Cal. Code Regs. Tit. 9, § 1850.207
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20). Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Part 438, Subpart F.
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).