N.D. Admin. Code 75-01-03-03 : Department of Human Services —01 - General Administration —01-03 - Appeals and Hearings —01-03-03 - Fair hearing - Who may receive

1. An opportunity for a fair hearing is available to any applicant for or recipient of Medicaid, children's health insurance program, economic assistance programs, intellectual disabilities - developmental disabilities program management services, or Medicaid eligibility benefits who requests a hearing in the manner set forth in this chapter and who is dissatisfied:
a. Because an application was denied or not acted upon with reasonable promptness; or
b. Because county agency or department action has resulted in the suspension, reduction, discontinuance, or termination of benefits.
2. An opportunity for a fair hearing is available to any resident who believes a facility has erroneously determined that the resident must be transferred or discharged.
3. An opportunity for a fair hearing is available to any individual who requests it because the individual believes the department has made an erroneous determination with regard to the preadmission and review requirements of 42 U.S.C. 1396r(e)(7).
4. An opportunity for a fair hearing is available to any individual whose Medicaid benefits are administered through a managed care organization and has received a notice of resolution the managed care organization is upholding the adverse benefit determination or failed to adhere to the notice and timing requirements of 42 CFR 438.408(b)(1) and (2).
5. An opportunity for a fair hearing is available to a parent, custodian, or legal guardian who requests it because the parent, custodian, or legal guardian believes the department has erroneously denied or terminated an autism voucher under chapter 75-03-38.
6. The department may, on its own motion, review individual cases and make determinations binding upon a county agency. An applicant or recipient aggrieved by such determination shall upon request be afforded the opportunity for a fair hearing. All references in this chapter to appeals from decisions of county agencies must be understood to include appeals taken from determinations made by the department.
7. A fair hearing request may be denied or dismissed when the sole issue is one of state or federal law requiring automatic benefit adjustments for classes of recipients unless the reason for an individual appeal is incorrect benefit computation.
8. The claimant may first seek corrective action from the department or claimant's county agency before filing a request for a fair hearing.
9. If a claimant dies after a request for a fair hearing has been filed by the claimant, and before the decision of the department has been rendered in the case, the proceedings may be continued on behalf of the claimant's estate, or any successor, as that term is defined in North Dakota Century Code section 30.1-01-06, of the claimant if a personal representative of the estate has been appointed.
10. If a dissatisfied claimant dies before the claimant can file a request for a fair hearing, the duly appointed personal representative of the claimant's estate, or any successor, as that term is defined in North Dakota Century Code section 30.1-01-06, of the claimant if no personal representative of the estate has been appointed, may file such request when the claimant was dissatisfied with the denial of the claimant's application for assistance, or was dissatisfied with the benefits the claimant was receiving prior to the claimant's death.
11. A fair hearing under this section is available only if:
a. Federal law or regulation requires that a fair hearing be provided; or
b. The appeal is related to the autism voucher and intellectual disabilities - developmental disabilities program management services; and
c. The dissatisfied claimant timely perfects an appeal.

N.D. Admin Code 75-01-03-03

Effective September 1, 1979; amended effective January 1, 1984; February 1, 1995; August 1, 2005.
Amended by Administrative Rules Supplement 368, April 2018, effective 4/1/2018.

General Authority: NDCC 28-32-02, 50-06-16

Law Implemented: NDCC 50-06-05.1