Minnesota Administrative Rules

9505.0130 RIGHT TO APPEAL; APPEAL PROCESS.

Subpart 1.

Rights of applicant or recipient.

An applicant or recipient of medical assistance has the right to a hearing:

A.

if the local agency fails to act on the application within required time limits;

B.

if eligibility is denied or terminated;

C.

if the recipient's spend down is increased;

D.

if the recipient's choice of provider is restricted;

E.

if payment for a health insurance premium is denied because the department determines the insurance policy is not cost-effective for the medical assistance program; and

F.

if the department denies a recipient's request for health service.

A local agency shall not reduce, suspend, or terminate eligibility when a recipient appeals under subpart 2 before the later of the effective date of the action or within ten days of the agency's mailing of the notice unless the recipient requests in writing not to receive continued medical assistance while the appeal is pending.

Subp. 2.

Appeal process.

An applicant or recipient may appeal the proposed action within 30 days after the notice was sent to the applicant or recipient by the local agency. The appeal must be filed within 30 days of the local agency's action. However, a delay to 90 days is allowed if an appeals referee finds that the applicant has good cause for failing to request a hearing within 30 days. The applicant's or recipient's written appeal and request for hearing must be submitted to the department by the local agency. A state appeals referee shall conduct a hearing and recommend to the commissioner a course of action in the case. The commissioner shall issue an order affirming, reversing, or modifying the action or decision of the local agency or the department. This order is binding upon the local agency and the aggrieved party unless an appeal is filed with the district court within 30 days of the commissioner's order, under Minnesota Statutes, section 256.045, subdivision 7.

Subp. 3.

[Repealed, 26 SR 977]

Subp. 4.

Right to review records.

A local agency shall allow a person, the person's authorized representative, or the person's guardian to review the records that the local agency maintains concerning the person's medical assistance application and eligibility, except for records to which access is denied under Minnesota Statutes, chapter 13. A local agency shall make the records available to the person, the person's authorized representative, or the person's guardian as soon as possible but no later than the fifth business day after the date of the request. When a person, the person's authorized representative, or the person's guardian asks for photocopies of material from the person's records, the local agency shall provide one copy of each page at no cost to the individual making the request.

Statutory Authority:

MS s 256B.04; L 2000 c 340 s 17

History:

11 SR 1069; 26 SR 977

Published Electronically:

August 13, 2013