1. (1)(a) An aggrieved person shall request a hearing by:

   1. (i) completing the DIH Form to Request a State Fair Hearing; and

      1. (ii) submitting the form by mail, fax, or other electronic means as directed on the form or the notice of agency action.
   2. (b) The request shall explain why the aggrieved person is seeking agency relief.

2. (2) Except as described in Section R410-14-20, a hearing shall be requested within the following deadlines:

   1. (a) a medical assistance provider or member shall request a hearing within 30 calendar days from the date that DIH sends a written notice of agency action.
   2. (b) a medical assistance member shall request a hearing with DWS regarding medical assistance eligibility within 90 calendar days from the date the agency sends a written notice of agency action.
   3. (c) a medical assistance member shall request a hearing with the office regarding a determination of disability for medical assistance eligibility within 90 calendar days from the date that DIH sends a written notice of agency action.
   4. (d) a medical assistance member shall request a hearing regarding approval or denial of a scope of service within 30 calendar days from the date the agency sends written notice of agency action.
3. (3) A hearing request that an aggrieved person sends through the mail is considered filed on the date of the postmark. If the postmark date is illegible, erroneous, or omitted, the request is considered filed on the date the agency receives it, unless the sender can demonstrate the mailing date through credible evidence.
4. (4) Failure to submit a timely request for a hearing constitutes a waiver of an individual's due process rights.

5. (5) The office may dismiss a request for a hearing if the aggrieved person:

   1. (a) withdraws the hearing request in writing;
   2. (b) verbally withdraws the hearing request at a prehearing conference;
   3. (c) fails to appear or participate in a scheduled proceeding without good cause;
   4. (d) prolongs the hearing process without good cause;
   5. (e) cannot be located or agency mail is returned without a forwarding address;
   6. (f) fails to provide medical records that the agency requests; or
   7. (g) does not respond to any correspondence from the office.

KEY: Medicaid

Date of Last Change: September 19, 2025

Notice of Continuation: August 12, 2022

Authorizing, and Implemented or Interpreted Law: 26B-1-202(1); 26B-1-204; 63G-4-102