Kan. Admin. Regs. § 129-9-11
Current through Register Vol. 44, No. 2, January 9, 2025
Section 129-9-11 - Request for state fair hearing; timeliness(a) For each request for a standard state fair hearing under this article of the division's regulations to be considered timely, the request shall be received by the MCE, the secretary, or the secretary's designee for the state fair hearing according to the following time frames: (1) For each request by the provider involving the MCE's action or the MCE's denial of an authorization for a new healthcare service that was not reviewed by the external independent third-party reviewer, the request shall be received by the MCE or the secretary's designee for the state fair hearing within 120 days from the date of the adequate notice of appeal resolution, pursuant to K.S.A. 39-709h(e)(4) and amendments thereto. If the 120th day falls on a non-business day for the state, the time period for receipt of a request for a state fair hearing shall be extended to the next business day on which the department is open for business. Three days shall be added to the 120-day response period if the notice is served by U.S. mail or electronic means. If the third day falls on a non-business day for the state, the time period shall be extended to the next business day on which the department is open for business.(2) For each request by the provider involving the MCE's action or the MCE's denial of an authorization for a new healthcare service that was reviewed by the external independent third-party reviewer, the request shall be received by the MCE or the secretary's designee for the state fair hearing within 30 days from the date of the MCE's adequate notice of external review decision, pursuant to K.S.A. 39-709i and amendments thereto. If the 30th day falls on a non-business day for the state, the time period for receipt of a request for a state fair hearing shall be extended to the next business day on which the department is open for business. Three days shall be added to the 30-day response period if the notice is served by U.S. mail or electronic means. If the third day falls on a non-business day for the state, the time period shall be extended to the next business day on which the department is open for business.(3) For each request by the provider involving an action by the secretary, the request shall be received by the secretary or the secretary's designee within 30 days from the date of the secretary's adequate notice of action, pursuant to 129-9-10 . If the 30th day falls on a non-business day for the state, the time period for receipt of a request for a state fair hearing shall be extended to the next business day on which the department is open for business. Three days shall be added to the 30-day response period if the notice is served by U.S. mail or electronic means. If the third day falls on a non-business day for the state, the time period shall be extended to the next business day on which the department is open for business.(b) Any provider may submit an oral or written request for a state fair hearing with the MCE or the secretary. The MCE, the secretary, or the secretary's designee for the state fair hearing may require that the provider submit the request for a state fair hearing in writing. Oral, telephonic, or electronic requests for a standard or expedited state fair hearing may not be submitted to the secretary's designee for the state fair hearing.(c) Any request for a state fair hearing made by telephone or other electronic means and received by the MCE or the secretary during normal business hours may be accepted as a valid request for a state fair hearing by the MCE or the secretary if the request and proof of receipt are documented, dated, and reduced to writing by the MCE or the secretary. The date and time of the telephonic or electronic request for a state fair hearing shall be used to determine the timeliness of the request even if there is a delay by the MCE or the secretary in reducing the request to writing. Oral, telephonic, or electronic requests for a state fair hearing may not be submitted to the secretary's designee for the state fair hearing.(d) Each request for a state fair hearing received by the MCE or the secretary shall be forwarded to the secretary's designee for the state fair hearing within one business day of receipt.(e) If a written request for a state fair hearing is received by the MCE, the MCE shall date-stamp the request when received as proof of receipt. The timeliness standards specified in subsection (a) shall apply with the date of receipt by the MCE being used to determine the timeliness of the request.(f) If the provider sends a written request for a state fair hearing directly to the secretary's designee for the state fair hearing, the timeliness standards specified in subsection (a) shall apply with the date of receipt by the secretary's designee being used to determine the timeliness of the request.(g) If the request for a state fair hearing is not received within the response periods specified in subsection (a), the request shall be deemed untimely and shall be dismissed.(h) The presiding officer shall issue an initial order in a standard state fair hearing within 90 days from the date the presiding officer receives a request for a state fair hearing, except when the request for a state fair hearing involves the issue being reviewed by the external independent third-party reviewer or when the presiding officer allows an extension.(i) Unless preempted by federal law, a request for payment of a claim by a non-participating provider to a reimbursing entity shall be treated as a request to use all applicable provisions from statutes, regulations, policies, state plans, amendments to a state plan, waivers, CMS-approved contracts between the secretary and the MCE, and the provider agreements that the reimbursing entity would use in determining a claim for reimbursement from a participating provider.(j) The presiding officer shall issue an initial order on each state fair hearing request within the time limits specified in subsection (h), unless one of the following conditions is met: (1) The presiding officer cannot reach a decision because the appellant requests a delay or fails to take a required action.(2) There is an administrative or other emergency beyond the control of the presiding officer or the secretary. The presiding officer shall document the reasons for any delay in the appellant's record.Kan. Admin. Regs. § 129-9-11
Authorized by and implementing K.S.A. 39-709i, 65-1,254, and 75-7403; adopted by Kansas Register Volume 43, No. 50; effective 12/27/2024.