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COMBINED MEDICAID 1505-1 Fair Hearings, Administrative Reviews, and Appeals Supersedes: FMA 1506-1 and MA 1506-1 (01/01/08), FMA and MA 1506-2, 1506-3 & 1506-4 (01/01/07) Reference: ARM 37.5.101; 103; 301; .304; .305; .307; .313; .316; .318; .322; .325; .328; .331; .334; .337; .503; .505; ARM 37.82.101; 42 CFR 431.200 through .246 Overview: All clients have the right to due process and to request a hearing; staff may assist the claimant in submitting and processing a hearing request. Department staff will not interfere with these rights. Centralized Fair Hearing Unit staff conduct hearings. A fair hearing (FH) is granted to any client who requests a hearing because: 1. Their application is denied or not processed timely; 2. They do not agree with any action to reduce or terminate their benefits; establish an over issuance or impose specific conditions to receive benefits; or 3. Their request for an additional level of coverage is denied or changed. A hearing request is the client’s/authorized representative’s clear communication that they want to present their case to an authority above the OPA. State law grants any 'real party in interest' (e.g., medical providers) the right to request a fair hearing and/or appeal a hearing decision. Fair hearing rights as well as information on continuing benefits pending the hearing decision and repayment requirements (if the decision supports the Department) are listed on the back of all adverse action notices. ADMINISTRATIVE REVIEWS: An Administrative Review (AR) is a meeting between the client (claimant)/their representative and HCSD Fair Hearing Unit staff. The AR is a chance to review and potentially resolve a dispute on the Department’s action, or to lessen any confusion at the hearing. An AR: 1. Identifies issues related to the adverse action; and 2. If possible, resolves, to the claimant’s satisfaction, any questions or issues related to the adverse action. An AR does not diminish, delay or void a client’s right to a fair hearing. • When the disputed issue is not resolved to the claimant’s satisfaction at the AR, the Hearing Officer must proceed with the hearing.