Current through September 30, 2024
Section 155.515 - Notice of appeal procedures(a)Requirement to provide notice of appeal procedures. The Exchange must provide notice of appeal procedures at the time that the- (1) Applicant submits an application; and(2) Notice of eligibility determination is sent under §§ 155.310(g) , 155.330(e)(1)(ii) , 155.335(h)(1)(ii) , and 155.610(i) .(b)General content on right to appeal and appeal procedures. Notices described in paragraph (a) of this section must contain-(1) An explanation of the applicant or enrollee's appeal rights under this subpart;(2) A description of the procedures by which the applicant or enrollee may request an appeal;(3) Information on the applicant or enrollee's right to represent himself or herself, or to be represented by legal counsel or another representative;(4) An explanation of the circumstances under which the appellant's eligibility may be maintained or reinstated pending an appeal decision, as described in § 155.525 ; and(5) An explanation that an appeal decision for one household member may result in a change in eligibility for other household members and that such a change will be handled as a redetermination of eligibility for all household members in accordance with the standards specified in § 155.305 .