Page 102

Official source

MS 0460 (2) b. Denial of payment for services; c. Services provided through Early and Periodic Screening, Diagnosis, and Treatment (EPSDT); and d. Issues related to managed care services or participation. 2. Clients can also request DMS hearings by calling the Administrative Services Branch directly, at 502-564-8196, ext. 3175. 3. [The only appeal process which applies to DMS hearings is a judicial review. The Cabinet Secretary/Secretary’s Designee does not review these cases.] 4. DCBS staff is responsible for hearings on Medicaid (MA) eligibility and follows the regular procedures for requesting an administrative hearing. 5. There are no fair hearing procedures for managed care, as the delivery method of MA is not a qualifying event for a fair hearing. Managed Care has a grievance procedure for issues such as dissatisfaction with a provider assignment. This is explained in more detail in the member handbook.

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Page 102

Official source

MS 0460 (2) b. Denial of payment for services; c. Services provided through Early and Periodic Screening, Diagnosis, and Treatment (EPSDT); and d. Issues related to managed care services or participation. 2. Clients can also request DMS hearings by calling the Administrative Services Branch directly, at 502-564-8196, ext. 3175. 3. [The only appeal process which applies to DMS hearings is a judicial review. The Cabinet Secretary/Secretary’s Designee does not review these cases.] 4. DCBS staff is responsible for hearings on Medicaid (MA) eligibility and follows the regular procedures for requesting an administrative hearing. 5. There are no fair hearing procedures for managed care, as the delivery method of MA is not a qualifying event for a fair hearing. Managed Care has a grievance procedure for issues such as dissatisfaction with a provider assignment. This is explained in more detail in the member handbook.