Section R382-1-8 - Agency Conferences, Fair Hearings, and Appeals(1) A CHIP applicant or beneficiary may request an agency conference in accordance with Section R414-301-5 at any time to resolve a problem without requesting an agency action under the Utah Administrative Procedures Act (UAPA).(2) The CHIP applicant or beneficiary, parent, legal guardian, or authorized representative may request an agency action, also called a fair hearing, if the individual disagrees with an agency decision regarding the individual's eligibility. The request for a fair hearing must be in accordance with Section R414-301-7. (3) The Department of Workforce Services shall conduct fair hearings on eligibility in accordance with Section R414-301-7.(4) If a CHIP beneficiary disagrees with a decision of the MCO regarding a covered benefit or service, the beneficiary may appeal the decision through the MCO. (a) A C H I P beneficiary must exhaust grievance remedies with the MCO before the beneficiary requests an agency action from the Department.(b) The CHIP beneficiary may file an appeal with the Department if the beneficiary disagrees with the MCO's resolution. The beneficiary must file the appeal within 60 days of the date that the MCO sends the resolution notice.(c) The Department shall conduct a review of the MCO's decision in accordance with 42 CFR 438.408 and issue a final decision to the CHIP beneficiary and the MCO.(d) The Department shall conduct all appeals in accordance with UAPA.(e) The CHIP beneficiary may continue to receive benefits if the beneficiary meets the conditions of 42 CFR 438.420.Utah Admin. Code R382-1-8
Amended by Utah State Bulletin Number 2022-14, effective 7/1/2022