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Effective: December 1, 2006 |
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27.15ar1 - Appeal Decisions (Archive) |
Archived: May 1, 2009 |
Human services judges do not make decisions at appeal hearings. The human services judges write recommended orders. The state appeals director makes the final decisions. The agency and the client receive copies of the state’s decision within 90 days from the appeal date.
For more information about MinnesotaCare good cause for failure to pay premiums or requesting voluntary cancellation, see MinnesotaCare Four Month Penalty.
When the appeals office reverses the MCRE or county agency decision, follow the directions in the appeal decision.
Required actions may include:
l Reconsideration of a previous denial or cancellation based on new information. The appeal decision will specify what additional information the client must provide.
l Approval of coverage for a denied application.
l Reinstatement of coverage for a terminated or canceled household.
l Reversal of a good cause finding.
l A partial reversal of an agency decision.
When a client who continues to receive coverage during the appeal process loses an appeal, implement the appeal decision beginning the first possible month. No additional notice is required.
The Appeals Office may deny or dismiss an appeal request if:
l The client, financially responsible person, or representative withdraws the appeal in writing.
l The county or DHS does not receive the appeal within the timeliness standard.
l The client, financially responsible person, or representative fails to appear for a hearing and cannot show good cause for not appearing.
l DHS has no jurisdiction to hear the appeal.
The human services judge recommends an order to the state appeals director, who then issues an order affirming, reversing, or modifying the action of the county or state agency.
If the commissioner's representative disagrees with the human services judge's recommendation, each party (agency and client) has 10 days to present additional written arguments on the matter.
The commissioner's representative then issues a decision.
The client, the county, or the state agency may request reconsideration by the state appeals director within 30 days after the date the state appeals director issues the order. A request for reconsideration should state the reasons the client, county, or state agency believes the original order is wrong.
The state appeals director may reconsider an order upon request of either party or on the commissioner's motion. The commissioner's representative will issue an amended order or an order affirming the original order.
The original order takes effect even if there is a request for reconsideration.
The client or the county or state agency may appeal to district court within 30 days after the date the commissioner's representative issued an order, an amended order, or an order affirming the original appeals order.
Either party may appeal to district court to enforce an appeal decision.
The commissioner's representative can order that the client receive benefits during the entire time of appeal. In most cases the Department order takes effect while the appeal to district court is pending.
Do not continue coverage during an appeal to district court unless the final Department order specifically directs you to do so.