Historically, the Bureau of Hearings and Appeals (BHA) has prioritized the scheduling and adjudication of Medical Assistance (MA) eligibility appeals over other types of appeals. Recently, however, beneficiaries and providers have experienced significant delays in the resolution of MA eligibility appeals. In some instances, the BHA is taking several months to schedule hearings on MA eligibility determinations. Generally, the BHA must take "final administrative action" within 90 days of the filing date of the appeal. "Final administrative action" means a decision by the hearing officer. If final administrative action is not taken within 90 days of the filing of the appeal, the Department of Human Services is required to authorize the payment of MA benefits to the provider on behalf of the resident pending the final administrative action. Interim assistance is not subject to restitution absent an affirmative misrepresentation by the beneficiary. In cases where the beneficiary is responsible for delaying the hearing process, the time limit for final administrative action is extended by the length of the delay.
Providers that are experiencing significant delays in the scheduling of eligibility hearings would be well-served by requesting interim assistance while the appeal is pending. If you have any questions regarding interim assistance or MA eligibility issues, please do not hesitate to contact Steven M. Montresor.