California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 8 - Enrollment Assistance › Section 6662 - Appeals Process

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Other than a determination made pursuant to Section
				6658, 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 Appeals 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				outcome of the informal resolution decision, the appeal may be withdrawn.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				the appeal is not withdrawn, it shall be automatically escalated to the second
				phase of the Appeals Process. 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
				appellant shall be allowed to present additional evidence during the second
				phase. 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 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A
				  Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Repealed by operation of Government Code section
				  11346.1(g)
				  (Register 2014, No. 7).
3. New section filed 2-10-2014 as an
				  emergency pursuant to Government Code section
				  11346.1,
				  subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of
				  Compliance must be transmitted to OAL by 5-12-2014 or emergency language will
				  be repealed by operation of law on the following day.
4. New section
				  refiled 5-12-2014 as an emergency pursuant to Government Code section
				  11346.1,
				  subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of
				  Compliance must be transmitted to OAL by 8-11-2014 or emergency language will
				  be repealed by operation of law on the following day.
5. New section
				  refiled 7-21-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats 2014, c. 31); operative 7-21-2014
				  (Register 2014, No. 30). A Certificate of Compliance must be transmitted to OAL
				  by 7-15-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
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 2-10-2017 or the language in the
				  emergency order of 7-21-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Certificate of Compliance
				  as to 7-21-2014 order, including further amendment of subsection (a) and NOTE,
				  transmitted to OAL 11-6-2015 and filed 12-23-2015 (Register 2015, No.
				  52).
Note: Authority cited: Sections
					 100502 and
					 100504,
					 Government Code. Reference: Sections
					 100502 and
					 100503,
					 Government Code; and 45
					 C.F.R. §§
												155.205 and
					 155.210.