California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 7 - Appeals Process for the Individual Exchange › Section 6600 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In addition to the definitions in Section
				  6410 of Article 2 of this chapter,
				  for purposes of this Article, the following terms shall mean:
"Appeal Record" means the appeal decision, all papers and
				  requests filed in the proceeding, and, if a hearing was held, the transcript or
				  recording of hearing testimony or an official report containing the substance
				  of what happened at the hearing and any exhibits introduced at the
				  hearing.
"Appeal Request" means a clear expression, either orally or
				  in writing, by an applicant, enrollee, employer, or employee to have any
				  Exchange eligibility determinations or redeterminations reviewed by an appeals
				  entity.
"Appeals Entity" means a body designated to hear appeals of
				  any Exchange eligibility determinations or redeterminations. The California
				  Department of Social Services shall be designated as the Exchange appeals
				  entity.
"Appellant" means the applicant or enrollee who is requesting
				  an appeal.
"De Novo Review" means a review of an appeal without
				  deference to prior decisions in the case.
"Eligibility Determination" means a determination that an
				  applicant or enrollee is eligible for an IAP, for enrollment in a QHP, or for
				  any enrollment periods, in accordance with Sections
				  6472,
				  6474, and
				  6476 of Article 5 of this
				  chapter.
"Evidentiary Hearing" means a hearing conducted where new
				  evidence may be presented.
"Statement of Position" means a writing that describes the
				  appellant's and the Exchange's positions regarding an appeal, as specified in
				  Section 10952.5 of the Welfare and
				  Institution Code.
"Vacate" means to set aside or legally void a previous
				  action.
1. New article
				  7 (sections
				  6600-6620) and section filed
				  9-30-2013 as a deemed emergency pursuant to Government Code section
				  100504(a)(6);
				  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				  be transmitted to OAL by 4-1-2014 or emergency language will be repealed by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 article 7 (sections
				  6600-6620) and section, with
				  amendments, refiled 4-1-2014 as a deemed emergency pursuant to Government Code
				  section
				  100504(a)(6);
				  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. Refiling of 4-1-2014
				  action on 6-30-2014, including further amendments, as a deemed emergency
				  pursuant to Government Code section
				  100504(a)(6);
				  operative 6-30-2014 (Register 2014, No. 27). A Certificate of Compliance must
				  be transmitted to OAL by 9-29-2014 or emergency language will be repealed by
				  operation of law on the following day.
4. New article 7 (sections
				  6600-6620) and section refiled
				  9-30-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-30-2014
				  (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 4 (Register 2014, No.
				  45).
6. Editorial correction of HISTORY 4 (Register 2014, No.
				  50).
7. New article 7 (sections
				  6600-6620) and section refiled
				  12-12-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 12-12-2014
				  (Register 2014, No. 50). 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.
8. New article 7 (sections
				  6600-6620) and new section refiled
				  5-11-2015 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 5-11-2015
				  (Register 2015, No. 20). 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.
9. 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 5-11-2015 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
10. New article 7 (sections
				  6600-6620) and new section refiled
				  9-17-2015 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31) and Senate Bill 75 (Stats.
				  2015, Ch. 18); operative 9-17-2015 (Register 2015, No. 38). A Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 pursuant to Government Code
				  section
				  100504 or
				  the language in the emergency order of 9-17-2015 will be repealed by operation
				  of law on the following day.
11. New article 7 (sections
				  6600-6620) and new section refiled
				  12-14-2015 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31) and Senate Bill 75 (Stats.
				  2015, Ch. 18); operative 12-14-2015 (Register 2015, No. 51). A Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 pursuant to Government Code
				  section
				  100504 or
				  the language in the emergency order of 12-14-2015 will be repealed by operation
				  of law on the following day.
12. New article 7 (sections
				  6600-6620) and new section refiled
				  6-6-2016 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31) and Senate Bill 75 (Stats.
				  2015, Ch. 18); operative 6-6-2016 (Register 2016, No. 24). A Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 pursuant to Government Code
				  section
				  100504 or
				  the language in the emergency order of 6-6-2016 will be repealed by operation
				  of law on the following day.
13. Senate Bill 833 (Stats. 2016, c.
				  30) modified Government Code section
				  100504(a)(6)
				  to extend the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Refiling of 6-6-2016 order on 9-30-2016 as a deemed emergency pursuant
				  to Government Code section
				  100504(a)(6);
				  operative 9-30-2016 (Register 2016, No. 40). A Certificate of Compliance must
				  be transmitted to OAL by 10-1-2018 pursuant to Government Code section
				  100504(a)(6)
				  or emergency language will be repealed by operation of law on the following
				  day.
14. New article 7 (sections
				  6600-6620) and new section refiled
				  2-16-2017 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 833 (Stats. 2016, c. 30), Senate Bill 75 (Stats.
				  2015, c. 18) and Senate Bill 857 (Stats. 2014, c. 31); operative 2-16-2017
				  (Register 2017, No. 7). A Certificate of Compliance must be transmitted to OAL
				  by 10-1-2018 pursuant to Government Code section
				  100504(a)(6)
				  or the language in the emergency order of 2-16-2017 will be repealed by
				  operation of law on the following day.
15. New article 7 (sections
				  6600-6620) and new section refiled
				  10-26-2017 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 833 (Stats. 2016, c. 30), Senate Bill 75 (Stats.
				  2015, c. 18) and Senate Bill 857 (Stats. 2014, c. 31); operative 10-26-2017
				  (Register 2017, No. 43). A Certificate of Compliance must be transmitted to OAL
				  by 10-1-2018 pursuant to Government Code section
				  100504(a)(6)
				  or the language in the emergency order of 10-26-2017 will be repealed by
				  operation of law on the following day.
16. Certificate of Compliance
				  as to 10-26-2017 order, including further amendment of section, transmitted to
				  OAL 8-10-2018 and filed 9-24-2018; amendments effective 9-24-2018 pursuant to
				  Government Code section
				  11343.4(b)(3)
				  (Register 2018, No. 39).
Note: Authority cited: Section
					 100504,
					 Government Code. Reference: Sections
					 100503 and
					 100506,
					 Government Code; and 45 CFR
					 Section
					 155.500.