Reference - Beneficiary Problem Resolution

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

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