- (a) The agency must issue and publicize its hearing procedures.
(b) The agency must, at the time specified in paragraph (c) of this section, inform every applicant or beneficiary in writing—
- (1) Of his or her right to a fair hearing and right to request an expedited fair hearing;
- (2) Of the method by which he may obtain a hearing;
- (3) That he may represent himself or use legal counsel, a relative, a friend, or other spokesman; and
- (4) Of the time frames in which the agency must take final administrative action, in accordance with § 431.244(f).
- (c) The agency must provide the information required in paragraph (b) of this section—(1) At the time that the individual applies for Medicaid;
- (2) At the time the agency denies an individual's claim for eligibility, benefits or services; or denies a request for exemption from mandatory enrollment in an Alternative Benefit Plan; or takes other action, as defined at § 431.201; or whenever a hearing is otherwise required in accordance with § 431.220(a);
- (3) At the time a skilled nursing facility or a nursing facility notifies a resident in accordance with § 483.15 of this chapter that he or she is to be transferred or discharged; and
- (4) At the time an individual receives an adverse determination by the State with regard to the preadmission screening and annual resident review requirements of section 1919(e)(7) of the Act.
- (d) If, in accordance with § 431.10(c)(1)(ii), the agency has delegated authority to the Exchange or Exchange appeals entity to conduct the fair hearing, the agency must inform the individual in writing that—
- (1) He or she has the right to have his or her hearing before the agency, instead of the Exchange or the Exchange appeals entity; and
- (2) The method by which the individual may make such election;
- (e) The information required under this subpart must be accessible to individuals who are limited English proficient and to individuals with disabilities, consistent with § 435.905(b) of this chapter, and may be provided in electronic format in accordance with § 435.918 of this chapter.
[44 FR 17932, Mar. 29, 1979, as amended at 57 FR 56505, Nov. 30, 1992; 58 FR 25784, Apr. 28, 1993; 78 FR 42301, July 15, 2013; 81 FR 68847, Oct. 4, 2016; 81 FR 86448, Nov. 30, 2016]