1. (1) A CHIP applicant or member may request an agency conference in accordance with Section R414-301-5 at any time to resolve a problem without requesting an agency action under the Utah Administrative Procedures Act (UAPA).
2. (2) The CHIP applicant or member, parent, legal guardian, or authorized representative may request an agency action, also called a fair hearing, if the individual disagrees with an agency decision regarding the individual's eligibility. The request for a fair hearing must be in accordance with Section R414-301-7.
3. (3) The Department of Workforce Services shall conduct fair hearings on eligibility in accordance with Section R414-301-7.

4. (4) If a CHIP member disagrees with a decision of the MCO regarding a covered benefit or service, the member may appeal the decision through the MCO.

   1. (a) A CHIP member must exhaust grievance remedies with the MCO before the member requests an agency action from the Department.
   2. (b) The CHIP member may file an appeal with the Department if the member disagrees with the MCO's resolution. The member must file the appeal within 60 days of the date that the MCO sends the resolution notice.
   3. (c) The Department shall conduct a review of the MCO's decision in accordance with 42 CFR 438.408 and issue a final decision to the CHIP member and the MCO.
   4. (d) The Department shall conduct all appeals in accordance with UAPA.
   5. (e) The CHIP member may continue to receive benefits if the member meets the conditions of 42 CFR 438.420.

KEY: children's health benefits, fair hearings

Date of Last Change: November 5, 2023

Notice of Continuation: April 6, 2023

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-902