Iowa Admin. Code r. 441-7.4
Current through Register Vol. 47, No. 11, December 11, 2024
Rule 441-7.4 - Initiating an appeal(1)Exhaustion of remedies. An appellant shall only be granted a contested case hearing if the appellant has exhausted all other appeal remedies available to the party-in-interest. An appellant should refer to program-specific provisions for the appropriate procedures applicable to specific programs.(2)Medicaid managed care enrollees exhaustion of remedies.a. A Medicaid managed care enrollee shall be granted a contested case hearing only if the enrollee has either received a decision from a managed care organization in the time and manner required by rule 441-73.12 (249A) or has been deemed to have exhausted the managed care organization appeals under paragraph 7.4(2)"b."b. If a Medicaid enrollee's managed care organization fails to provide a decision in the time and manner required by rule 441-73.12 (249A), the enrollee shall be deemed to have exhausted the managed care organization's appeals process and may initiate a contested case hearing.(3)Time to appeal. For a contested case hearing to be granted, the following appeal timelines must be met:a.Supplemental Nutrition Assistance Program (SNAP), Medicaid eligibility, healthy and well kids in Iowa (hawki), fee-for-service Medicaid coverage, family planning program and autism support program. On or before the ninetieth day following the date of notice of an adverse benefit determination.b.Managed care organization medical services coverage. On or before the one hundred twentieth day following the date of exhaustion, actual or deemed, of the managed care organization appeal process outlined in rule 441-73.12(249A).f.Dependent adult abuse. Within six months of the date of notice of the action as provided in Iowa Code section 235B.10.g.Child abuse. For appeals regarding child abuse, the person alleged responsible for the abuse must appeal on or before the ninetieth day following the date of notice of the action as provided in Iowa Code section 235A.19. A subject of a child abuse report, other than the alleged person responsible for the abuse, may file a motion to intervene in the appeal on or before the tenth day following the date of notice of the right to intervene.h.Assistance program overpayments. For appeals pertaining to the family investment program, refugee cash assistance, PROMISE JOBS, child care assistance, medical assistance, healthy and well kids in Iowa (hawki), family planning program or Supplemental Nutrition Assistance Program (SNAP) overpayments, the party-in-interest's right to appeal the existence, computation and amount of the overissuance or overpayment begins when the department sends the first notice informing the party-in-interest of the overissuance or overpayment.i.All other appeals. For all other appeals, and unless federal or state law provides otherwise elsewhere, the appellant must appeal on or before the thirtieth day following the date of notice of the action being appealed. If such an appeal is made more than 30 days, but less than 90 days, of the date of notice, the director or director's designee may, at the director's or designee's sole discretion, allow a contested case hearing if the delay was for good cause, substantiated by the appellant.(4)Written and oral notification. The department shall advise each applicant and recipient of the right to appeal any adverse decision affecting the person's status. a. Written notification of the following shall be given at the time of application and at the time of any agency action affecting the claim for assistance.(1) The right to request a hearing.(2) The procedure for requesting a hearing.(3) The right to be represented by others at the hearing unless otherwise specified by statute or federal regulation.b. Written notification shall be given on the application form and all notices of decision.Iowa Admin. Code r. 441-7.4
ARC 1261C, IAB 1/8/2014, effective 3/1/2014Amended by IAB March 11, 2020/Volume XLII, Number 19, effective 4/15/2020Amended by IAB July 28, 2021/Volume XLIV, Number 2, effective 9/1/2021Amended by IAB February 8, 2023/Volume XLV, Number 16, effective 4/1/2023Adopted by IAB May 29, 2024/Volume XLVI, Number 25, effective 7/3/2024