Kan. Admin. Regs. § 129-9-10

Current through Register Vol. 44, No. 2, January 9, 2025

Section 129-9-10 - When a state fair hearing is required

(a) Any provider may submit a request for a state fair hearing if the provider identifies an action by the MCE or the secretary as the basis for the request. Any provider may submit a request for a state fair hearing following receipt of the MCE's notice of external review decision if the provider identifies the MCE's denial of an authorization for a new healthcare service or an action that was the subject of the external review as the basis for the request.

(b) If the basis for the state fair hearing request is an action by the MCE or a denial of an authorization for a new healthcare service by the MCE, the provider shall first meet any requirements stated in the state plan, an amendment to the state plan, a waiver, or a CMS-approved contract between the secretary and the MCE before the provider may request a state fair hearing. Failure to meet any contractual preconditions shall be grounds for dismissing the request for a state fair hearing. The provider shall submit the request for a state fair hearing in accordance with the timeliness requirements in 129-9-11(a)(1).

(c) If the basis for the state fair hearing request is an action by the secretary, the provider shall first meet any requirements stated in the state plan, an amendment to a state plan, or a waiver before the provider may request a state fair hearing. Failure to meet any contractual preconditions shall be grounds for dismissing the request for a state fair hearing. If the secretary's action is a termination or limitation of the KMAP provider's status as the KMAP provider, the KMAP provider may appear before the secretary regarding the question of continuing eligibility as a KMAP provider according to 129-9-15 . The provider shall submit the request for a state fair hearing in accordance with the timeliness requirements in 129-9-11(a)(3).

(d) If the basis for the state fair hearing request is an action by the MCE or a denial of an authorization for a new healthcare service by the MCE and the denial has been reviewed by the external independent third-party reviewer, the provider shall first meet any requirements stated in the state plan, an amendment to a state plan, a waiver, or a CMS-approved contract between the secretary and the MCE before the provider may request a state fair hearing. Failure to meet any contractual preconditions shall be grounds for dismissing the request for a state fair hearing. The provider shall submit the request for a state fair hearing in accordance with the timeliness requirements in 129-9-11(a)(2).

(e) The granting of a state fair hearing shall not be required of the secretary if the sole issue is a federal or state law requiring an automatic change adversely affecting some or all providers.

(f) Each request for a state fair hearing received by the secretary or the MCE shall be forwarded to the secretary's designee for the state fair hearing within one business day by the secretary or the MCE. Each oral request for a state fair hearing shall be reduced to writing by the secretary or the MCE before the request is forwarded.

(g) The provider's right to request a state fair hearing shall not be limited or interfered with by the secretary or the MCE.

Kan. Admin. Regs. § 129-9-10

Authorized by and implementing K.S.A. 651,254 and 75-7403; adopted by Kansas Register Volume 43, No. 50; effective 12/27/2024.