Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 610.000 - MassHealth: Fair Hearing Rules › Section 610.015 - Time Limits

Current through Register 1525, July 5, 2024
(A)
Timely Notice
. Before an intended appealable action,
			 the MassHealth agency must send a written timely notice to the member except as
			 provided in
			 130
			 CMR 610.027. A timely notice is a notice
			 mailed at least ten days before the action. Such notice must include a
			 statement of the right of appeal and the time limit for appealing.
(B)
Time Limitation on the Right
			 of Appeal
. The date of request for a fair hearing is the date on
			 which BOH receives such a request in writing. BOH must receive the request for
			 a fair hearing within the following time limits:
(1) 60 days after an applicant or member
			 receives written notice from the MassHealth agency of the intended action. Such
			 notice must include a statement of the right of appeal and the time limit for
			 appealing. In the absence of evidence or testimony to the contrary, it will be
			 presumed that the notice was received on the fifth day after mailing;
(2) unless waived by the BOH Director or his
			 or her designee, 120 days from
(a) the date of
			 application when the MassHealth agency fails to act on an
			 application;
(b) the date of
			 request for service when the MassHealth agency fails to act on such
			 request;
(c) the date of MassHealth
			 agency action when the MassHealth agency fails to send written notice of the
			 action; or
(d) the date of the
			 alleged coercive or otherwise improper conduct, but up to one year from the
			 date of the conduct if the appellant files an affidavit with the BOH Director
			 stating the following, and can establish the same at a hearing (failure to
			 substantiate the allegation either before or at the hearing will be grounds for
			 dismissal):
1. he or she did not know of the
			 right to appeal, and reasonably believed that the problem was being resolved
			 administratively or he or she was justifiably unaware of the conduct in
			 question; and
2. the appeal was
			 made in good faith.
(3) 30 days after a resident receives written
			 notice of an intent to discharge or transfer pursuant to
			 130
			 CMR 610.029(A);
(4) 30 days after a nursing facility
			 initiates a transfer or discharge or fails to readmit and fails to give the
			 resident notice;
(5) 14 days after
			 a resident receives written notice of an emergency intent to discharge or
			 emergency transfer pursuant to
			 130
			 CMR 610.029(B);
(6) 14 days after a resident receives written
			 notice of a transfer or discharge that is the result of a nursing facility's
			 failure to readmit the resident following hospitalization or other medical
			 leave of absence;
(7) for appeals
			 of a decision reached by a managed care contractor:
(a) 120 days after the member's receipt of
			 the managed care contractor's final internal appeal decision where the managed
			 care contractor has reached a decision wholly or partially adverse to the
			 member, provided however, that if the managed care contractor did not resolve
			 the member's appeal within the time frames described by
			 130
			 CMR 508.010(A), 120 days
			 after the date on which the time frame for resolving that appeal has
			 expired;
(b) for timing of request
			 for continuation of benefits pending appeal,
see
130
			 CMR 610.036.
(8) for appeals of PASRR determinations, 30
			 days after an individual receives written notice of his or her PASRR
			 determination. In the absence of evidence or testimony to the contrary, it will
			 be presumed that the notice was received on the fifth day after
			 mailing.