(01/01/2024, GCR 23-088)
(07/01/2019, GCR 18-126)
State fair hearing request. A clear expression, either orally or in writing, by an individual (applicant or enrollee) to have any decision by AHS affecting the individual's eligibility or level of benefits or services reviewed by the AHS Human Services Board.
State fair hearings entity. The Human Services Board, the body designated by law to hear State fair hearings of eligibility determinations or redeterminations. AHS determines whether an expedited eligibility appeal request meets the expedited appeal standard pursuant to§80.07(b), and decides expedited eligibility appeals for QHPs pursuant to §80.07(e).
(07/01/2019, GCR 18-126)
An individual, treating provider, or other person identified at §80.02(b) may request an expedited eligibility appeal by indicating that the time otherwise permitted for a State fair hearing could jeopardize the individual's life or health or ability to attain, maintain or regain maximum function. For the rule on expedited eligibility appeals, see §80.07.
(10/01/2021, GCR 20-005)
(07/01/2019, GCR 18-126)
(01/01/2024, GCR 23-088)
(07/01/2019, GCR 18-126)
Upon receiving a final and binding decision as described in §80.05(a)(2), AHS will promptly implement the decision.
(07/01/2019, GCR 18-126)
(01/15/2017, GCR 16-101)
(07/01/2019, GCR 18-126).
After receipt of a valid State fair hearing request or notice that concerns an appeal of a redetermination, if the individual (appellant) accepts eligibility pending an appeal, AHS will continue to consider the individual (appellant) eligible, while the State fair hearing is pending, for QHP, APTC, the Vermont Premium Reduction and federal or state CSR, as applicable, in accordance with the level of eligibility immediately before the redetermination being appealed.
(01/15/2017, GCR 16-101)
Part Eight Notes.
[1] For rules that govern internal appeals, State fair hearings grievances, and notices on Medicaid Services, refer to HCAR 8.100.
[2] 45 CFR § 155.505.
[3] 42 CFR § 431.206; 45 CFR § 155.515.
[4] 45 CFR §§ 155.505(e) and (f).
[5] 42 CFR § 431.220; 45 CFR § 155.505.
[6] 42 CFR § 431.221; 45 CFR § 155.520.
[7] 45 CFR § 155.520(a).
[8] 42 CFR § 431.221(e).
[9] 3 V.S.A. §3091(h).
[10] 3 V.S.A. §3091(h)(3); 45 CFR § 155.505(g).
[11] 45 CFR § 155.520(c).
[12] 45 CFR § 155.545(c).
[13] 42 CFR § 431.224; 45 CFR § 155.540.
[14] 42 CFR 431.224(b); 45 CFR 155.540(b)
[15] 45 CFR 155.540(b)(2)
[16] 42 CFR 431.224(b)
[17] 45 CFR 155.540
[18] 42 CFR 431.224
[19] 42 CFR 431.242(a)
[20] 42 CFR 431.244(f)(3)(i)
[21] 42 CFR 431.244(f)(4)(i)
[22] 42 CFR § 431.230; 45 CFR § 155.525.
13-008 Code Vt. R. 13-001-008-X
October 1, 2013 Secretary of State Rule Log #13-029
AMENDED:
July 30, 2014 Secretary of State Rule Log #14-026; July 15, 2015 Secretary of State Rule Log #15-030 [15-02]; May 11, 2016 Secretary of State Rule Log #16-E04; August 1, 2016 Secretary of State Rule Log #16-026; January 15, 2017 Secretary of State Rule Log #16-072, #16-073, #16-074, #16-075, #16-076, #16-077, #16-078, #16-079; May 2017 [Rule 13 170 001 moved from DCF to Human Services and divided into rules 13 001 001 through 13 001 008 ]; January 1, 2018 Secretary of State Rule Log #17-073; July 1, 2019 Secretary of State Rule Log #19-026; October 1, 2021 Secretary of State Rule Log #21-021; January 1, 2024 Secretary of State Rule Log #23-044
STATUTORY AUTHORITY:
3 V.S.A. §§818, 3052, 3053; 33 V.S.A. §§105, 1810, 1901