Okla. Admin. Code § 317:2-3-9

Current through Vol. 42, No. 3, October 15, 2024

Section 317:2-3-9 - Exhaustion of CE or DBM appeals

(a)Deemed exhaustion of CE or DBM appeals. If the CE and DBM fails to adhere to any timing or notice requirements as detailed in 42 C.F.R. § 438.408, the member is deemed to have exhausted the CE's or DBM's appeal process, and the member or the member's authorized representative may request a State fair hearing.

(b)Actual exhaustion of CE or DBM appeals. Except as allowed in (a), a member or the member's authorized representative may request a State fair hearing only after receiving notice from the CE and DBM upholding an adverse benefit determination and only within one hundred twenty (120) days after the date of the notice of appeal resolution.

(c)Exhaustion of CE or DBM appeals, determination. OHCA has sole authority to decide whether CE and DBM appeals have been exhausted for any member. Documentation, as submitted to OHCA by the CE and DBM within fifteen (15) calendar days of the request for State fair hearing, will serve as evidence to deemed exhaustion, actual exhaustion, or no exhaustion of the CE and DBM appeals process.

Okla. Admin. Code § 317:2-3-9

Adopted by Oklahoma Register, Volume 39, Issue 10, February 1, 2022, eff. 12/21/2021

Adopted by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/12/2022

Amended by Oklahoma Register, Volume 40, Issue 16, May 1, 2023, eff. 7/1/2023

Amended by Oklahoma Register, Volume 41, Issue 23, August 15, 2024, eff. 9/1/2024