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42 CFR Part 431, Subpart E — Fair Hearings for Applicants and Beneficiaries

Key findings used in wiki

  • Federal Medicaid rules require a fair-hearing opportunity when an assistance claim is denied or not acted on promptly, and for specified reductions, suspensions, or terminations of services or benefits.
  • Agencies must inform applicants and beneficiaries in writing of fair-hearing and expedited-hearing rights, how to request a hearing, representation options, and final-action time frames.
  • A notice must state the proposed action and effective date, specific reasons, supporting regulations or law, and hearing rights; advance notice generally applies with stated exceptions.
  • An agency must allow a reasonable time, up to 90 days from the mailed notice, to request a hearing and may assist with submitting and processing the request.
  • An expedited fair-hearing process applies when the ordinary time could jeopardize life, health, or ability to attain, maintain, or regain maximum function; continuation of services depends on the rule’s conditions and timing.