80.05 AHS Secretary’s decision and further appeal

6 42 CFR § 431.221; 45 CFR § 155.520. 7 45 CFR § 155.520(a). 8 42 CFR § 431.221(e). State fair hearings/expedited eligibility appeals Part 8 – Page 4 (Sec.80.00, Sub.80.05) (a) AHS Secretary’s decision9 (1) The Secretary of AHS will: (i) Adopt the Human Services Board’s decision or order, except that the Secretary may reverse or modify a decision or order of the Human Services Board if: (A) The Human Services Board’s findings of fact lack any support in the record; or (B) The decision or order misinterprets or misapplies State or federal policy or rule. (ii) Issue a written decision setting forth the legal, factual or policy basis for reversing or modifying a decision or order of the Human Services Board. (2) An order of the Human Services Board will become the final and binding decision of AHS upon its approval by the Secretary. The Secretary will either approve, modify or reverse the Human Services Board's decision and order within 15 days of the date of the Human Services Board’s decision and order. If the Secretary fails to issue a written decision within 15 days as required by this paragraph (a)(2), the Human Services Board’s decision and order will be deemed to have been approved by the Secretary. The Secretary will approve, modify, or reverse a Human Services decision and order entered pursuant to § 80.07(f) within the timelines set forth in § 80.07(f)(2). (b) Judicial review of AHS Secretary’s decision.10 An individual may, at the same time or independent of an HHS appeal (as described in (c) of this subsection), if applicable, appeal a decision of the AHS Secretary, made pursuant to § 80.05(a)(2), to the Supreme Court. Such appeals shall be pursuant to Rule 13 of the Vermont Rules of Appellate Procedure. The Supreme Court may stay the Secretary's decision upon the individual’s showing of a fair ground for litigation on the merits. The Supreme Court will not stay the Secretary's order insofar as it relates to a denial of retroactive benefits. (c) HHS appeal11 (1) An individual may make an appeal request to the HHS appeals entity within the time frame described in (2) of this paragraph (c) if the individual disagrees with the order of the Human Services Board or the AHS Secretary’s reversal or modification, made pursuant to § 80.05(a)(2), regarding: (i) A determination for any month that an individual is ineligible for APTC because the individual is considered eligible for other MEC under § 12.02(b) and § 23.00. This includes, but is not limited to, determinations of affordability and minimum value for employer-sponsored plans; (ii) An initial determination of eligibility, including the amount of APTC, the Vermont Premium Reduction and level of federal or state CSR; 9 3 VSA § 3091(h). 10 3 VSA § 3091(h)(3); 45 CFR § 155.505(g). 11 45 CFR § 155.520(c). State fair hearings/expedited eligibility appeals Part 8 – Page 5 (Sec.80.00, Sub.80.06) (iii) A redetermination of eligibility, including the amount of APTC, the Vermont Premium Reduction and level of federal or state CSR; and (iv) A failure by AHS to provide timely notice, as required by § 68.02, in regard to the determinations described in (i) through (iii) above. (2) An appeal request to the HHS appeals entity under (1) of this paragraph (c) must be made within 30 days of the date of the final and binding decision described in § 80.05(a)(2). Such a request may be made at the same time or independent of judicial review. (3) An individual who disagrees with the decision made by the HHS appeals entity may request review of the decision by the CMS Administrator. This administrative review process is described at 45 CFR § 155.505(g).