Code of Federal Regulations (Last Updated: October 10, 2024) |
Title 42 - Public Health |
Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
SubChapter D - State Children'S Health Insurance Programs (Schips) |
Part 457 - Allotments and Grants to States |
Subpart K - State Plan Requirements: Applicant and Enrollee Protections |
§ 457.1140 - Program specific review process: Core elements of review.
-
§ 457.1140 Program specific review process: Core elements of review.
In adopting the procedures for review of matters described in § 457.1130, a State must ensure that—
(a) Reviews are conducted by an impartial person or entity in accordance with § 457.1150;
(b) Review decisions are timely in accordance with § 457.1160;
(c) Review decisions are written; and
(d) Applicants and enrollees have an opportunity to—
(1) Represent themselves or have representatives of their choosing in the review process;
(2) Timely review their files and other applicable information relevant to the review of the decision;
(3) Fully participate in the review process, whether the review is conducted in person or in writing, including by presenting supplemental information during the review process; and
(4) Receive continued enrollment and benefits in accordance with § 457.1170.
[66 FR 2687, Jan. 11, 2001, as amended at 89 FR 22877, Apr. 2, 2024]