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Posts tagged "appeals"

BHA Hearing Delays and Requesting Interim Assistance

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.

MA Audit Issues Must Be Appealed at the Time of Audit

On July 10, 2013, the Commonwealth Court of Pennsylvania ruled that providers wishing to challenge adjustments made to their Medical Assistance ("MA") cost report must file a timely appeal from their audit report in order to preserve any audit issues for purposes of setting case-mix rates.

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