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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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the application or renewal form completed by the parent or guardian and the accompanying documentation • Schedules a review interview (to be held by telephone unless a face- to-face review is requested by the parent or guardian) • When the need for an expedited review is identified, an interview is scheduled consistent with 42 CFR 457.1160(a)

• Informs the parent or guardian in writing of the: o Date, time and location of the interview o Right to review records maintained by the contractor regarding the eligibility determination o Right to receive a copy of the relevant portions of the CHIP Procedures Manual and State or Federal law upon which the decision of ineligibility was based o Right to have a representative during the interview o Right to have appropriate interpretative service available during the interview if needed o Opportunity for continuation of coverage for an enrolled child • Provides the parent or guardian with a copy of the application and verification received from the Contractor • Informs the Contractor that the interview has been scheduled • Conducts the review interview • Issues a written decision within a reasonable time consistent with 42 CFR 457. 1180 • Sends confirmation that a request for a review has been withdrawn, if appropriate. (Withdrawal of a request may occur if the contractor, applicant or enrollee informs the Department that the request for review has been withdrawn for any reason. Example: contractor has resolved the matter at issue prior to the date of the scheduled review interview.)

When a Contractor is informed by the Department that a request for a review has been received, the contractor conducts a management review of the decision of ineligibility within two working days of the date of notification by the Department. The purpose of the management review is to assure that the decision made regarding ineligibility was appropriate. A written record of the management review is prepared. The Contractor informs the Review Officer of the results of the management review.

If the management review results in a determination that the eligibility decision was not appropriate, the Contractor:

• Informs the parent or guardian and review officer in writing that an error occurred and the child is eligible