California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6718 - Appeal Process

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Other than a determination made pursuant to Section
				6708, Certified Plan-Based
				Enroller Fingerprinting and Criminal Record Checks, a decision that an
				individual or entity is not eligible or qualified to participate or continue to
				participate in a program under this Article may be appealed to the Exchange in
				accordance with the requirements of this Section.
(b) The Exchange shall allow an applicant to
				request an appeal within 60 calendar days of the date of the notice of
				eligibility determination.
(c) The
				first phase of the Appeal Process shall include an informal review by the
				Exchange. The Exchange shall consider the information used to determine the
				appellant's eligibility as well as any additional relevant evidence presented
				during the course of the appeal. The Exchange shall make an informal resolution
				decision within 45 calendar days from the receipt of the appeal. The Exchange
				shall notify the appellant in writing of the decision.
(d) If the appellant is satisfied with the
				outcome of the informal resolution decision, the appeal may be withdrawn. If
				the appellant is dissatisfied with the outcome of the informal resolution, the
				appellant may escalate the appeal to the second phase of the Appeal Process by
				notifying the Exchange in writing and providing additional evidence within 45
				calendar days of the date of the decision in subdivision (c). During the second
				phase, an independent unit within the Exchange that had no involvement in the
				original eligibility or qualification determination or informal resolution
				decision shall review the eligibility or qualification of the appellant de
				novo. The Exchange shall consider all relevant evidence presented during the
				course of the appeal and notify the appellant in writing of the final decision
				within 60 calendar days from the receipt of the appeal.
1. New section
				  filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A
				  Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. New section refiled 4-1-2014 as an emergency; operative
				  4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be
				  transmitted to OAL by 6-30-2014 or emergency language will be repealed by
				  operation of law on the following day.
3. New section refiled
				  6-26-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014
				  (Register 2014, No. 26). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
4. New section refiled 10-2-2014 as an emergency pursuant to
				  Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 10-2-2014
				  (Register 2014, No. 40). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
5. Editorial correction of HISTORY 3 (Register 2014, No.
				  51).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government
				  Code section
				  100504(a)(6)
				  to change the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 or the language in the
				  emergency order of 10-2-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Certificate of Compliance
				  as to 10-2-2014 order transmitted to OAL 4-12-2016 and filed 5-23-2016
				  (Register 2016, No. 22).
Note: Authority cited: Sections
					 100503 and
					 100504,
					 Government Code. Reference: Section
					 100503,
					 Government Code; and 45 Code of Federal Regulations, Sections
					 155.415 and
					 156.1230.