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BAM 600 15 of 50 HEARINGS BPB 2026-014 5-1-2026

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

• Medical transportation. • Level of payment for home help services. • Denial or reduction of specific home help services related to activities of daily living. The administrative tribunal has the same authorities and responsibilities MOAHR has for MDHHS hearings. These include: • Granting/denying a hearing request. • Scheduling/rescheduling the hearing. • Notifying all parties of the time/place of the hearing. • Processing requests for in-person hearings. • Granting/denying requests for adjournments. • Issuing administrative subpoenas. • Reimbursing clients for hearings-related expenses. • Holding the hearing. • Issuing a decision and order. • Granting/denying a rehearing/reconsideration request. Note: Medicaid Recipients enrolled in a managed care health plan, Community Mental Health Services Program- Pre-Paid Inpatient Health Plan (CMHSP-PIHP), or MI Choice Waiver Agency who disagree with an adverse benefit determination made by the health plan/ CMHSP-PIHP/MI Choice Waiver Agency must first exhaust the internal appeal process with that organization prior to being eligible to request a state fair hearing from MOAHR. An adverse benefit determination includes, but is not limited to, the denial or limitation of a requested service or the denial, reduction, suspension of termination of a previously authorized service. Beneficiaries who have questions about the internal appeals process should be directed to call the organization who took the action (health plan/CMHSP-PIHP/MI Choice Waiver Agency) first. They can also be directed to the Beneficiary Help Line at 1-800- 642-3195, TTY users call 1-866-501-5656. MSA Determinations MA Only MSA determinations include all the following: • Denial of prior authorization.