REFERENCE

• 42 CFR §§ 431.211-214 Notice
• 42 CFR. § 431.220 When a Hearing Is Required
• 42 CFR § 431.244 (f) Expedited Appeals
• 42 CFR § 438 Managed Care
• 42 CFR § 438, Subpart F Grievance and Appeal System
• 42 CFR § 438.10 Information Requirements
• 42 CFR § 438.228 Grievance and Appeals Systems
• 42 CFR § 438.400 (b) Statutory Basis, Definitions, and Applicability
• 42 CFR §§ 438.402 (b) - (c) General Requirements
• 42 CFR §§ 438.404 (b) - (c) Timely and Adequate Notice of Adverse Benefit Determination
• 42 CFR §§ 438.406 (a) - (b) Handling of Grievances and Appeals
• 42 CFR §§ 438.408 (b) - (f) Resolution and notification: Grievances and appeals
• 42 CFR § 438.410 (c) Expedited resolution of appeals.
• 42 CFR § 438.414
• 42 CFR § 438.416 (b) Recordkeeping requirements
• 42 CFR § 438.420 Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State Fair Hearing are pending
• 42 CFR § 438.424 (a) Effectuation of reversed appeal resolutions
• 45 CFR § 92.8 Notice requirement
• 81 FR 27497 Medicaid and Children's Health Insurance Program (Chip) Programs; Medicaid Managed Care, Chip Delivered In Managed Care, and Revisions Related to Third Party Liability
• 81 FR § 31375 Nondiscrimination in Health Programs and Activities
• 9 CCR § 1810.200 Action
• 9 CCR § 1810.230.5 Notice of Action
• 9 CCR § 1810.216.2 Expedited Appeal
• 9 CCR § 1810.216.4 Expedited Fair Hearing
• 9 CCR §1810.440 MHP Quality Management Programs
• 9 CCR §1820.100 Definitions
• 9 CCR §1830.100 General Provisions
• 9 CCR §1830.205 Medical Necessity Criteria for MHP Reimbursement of Specialty Mental Health Services
• 9 CCR §1830.210 Medical Necessity Criteria for MHP Reimbursement for Specialty Mental Health Services for Eligible Beneficiaries Under 21 Years of Age
• 9 CCR §§1850.205 - 1850.215 Beneficiary Problem Resolution Processes
• 22 CCR § 51014.1 - 2 Medical Assistance Pending Fair Hearing Decision
• 22 CCR § 50179. Notice of Action Medi-Cal-Only Determinations or Redeterminations
• 22 CCR § 53858 (e) Member Grievance Procedures
• 28 CCR § 1300.67.04 Language Assistance Programs.
• 28 CCR §1300.68 (a) Grievance System
• HSC §1367.01 Health Care Service Plans
• HSC §1368 Grievance System
• DHCS All Plan Letter 17-006
• DHCS Information Notice: 18-010
• Beneficiary Request for Second Opinion BHSD# 11200.1
• Beneficiary Request for Second Opinion SUTS BHSD# 11200.2