Section 206-2-003 - INFORMAL DISPUTE RESOLUTION AND ADMINISTRATIVE APPEALSA client, guardian, or provider has the right to appeal a service authorization denial after all available appeals through the service authorization appeals process have been exhausted.
003.01COMMENCEMENT OF APPEAL PROCESS. A client, guardian, or provider may begin the appeal process by either:(A) Requesting an informal dispute resolution in writing within 14 calendar days following the service authorization denial; or(B) Requesting a formal administrative appeal in writing within 30 calendar days following the service authorization denial.003.02INFORMAL DISPUTE RESOLUTION SUSPENSION OF TIME PERIOD. If a client, guardian, or provider requests an informal dispute resolution, the 30-day period to request a formal appeal will be suspended, beginning on the day the Division receives the request for informal dispute resolution until the day the Division notifies the client, guardian, or provider of the outcome of the informal dispute resolution. Following the informal dispute resolution process, if the client, guardian, or provider still wishes to dispute the Division's decision, the client, guardian, or provider may request a formal appeal until the expiration of the 30-day period as calculated above.003.03INFORMAL DISPUTE RESOLUTION. Upon receiving a request for an informal dispute resolution, the Division will schedule a meeting between the client, guardian, or provider and the appropriate Department staff. An informal dispute resolution may be held in person, by video, or by telephone. The Division's Chief Clinical Officer or designee serves as the decision-maker for the informal dispute resolution process, and will issue a written decision.003.04ADMINISTRATIVE APPEAL. Administrative appeals are conducted in accordance with the Administrative Procedure Act, Neb. Rev. Stat. §§ 84-901 to 84-920.206 Neb. Admin. Code, ch. 2, § 003
Adopted effective 6/27/2021