Oregon Health Authority
Health Systems Division: Medical Assistance Programs - Chapter 410
Division 141
OREGON HEALTH PLAN
410-141-3905
Grievances & Appeals: Expedited Contested Case Hearings
(1) An MCE shall have a system in place to ensure its members and providers have access to expedited review for MCE’s action by requesting an expedited contested case hearing. Contested case hearings are conducted pursuant to ORS 183.411 to 183.497 and the Attorney General’s Uniform and Model Rules of Procedure for the Office of Administrative Hearings, OAR 137-003-0501 to 137-003-0700. Processes for expedited contested case hearings are provided in OAR 410-120-1860 Contested Case Hearing Procedures.
(2) A member or provider who believes that taking the time for a standard resolution of a request for a contested case hearing could seriously jeopardize the member’s life or health or ability to attain, maintain, or regain maximum function may request an expedited contested case hearing.
(3) A request for an expedited hearing for a service that has already been provided (post-service) to the member will not be granted.
(4) The member may not request an expedited contested case hearing without first completing an appeal or expedited appeal with the MCE, subject to the exception in OAR 410-141-3900(3). When a member files a hearing request prior to completion of an MCE appeal or expedited appeal, the Authority shall follow procedures set forth in OAR 410-141-3900.
(5) Expedited hearings are requested using Authority form MSC 443 or other Authority-approved appeal or hearing request forms.
(6) The MCE shall submit relevant documentation to the Authority within two working days. The Authority shall decide within two working days from the date of receiving the relevant documentation whether the member is entitled to an expedited contested case hearing.
(7) If the Authority denies a request for an expedited contested case hearing, the Authority shall:
(a) Handle the request for a contested case hearing in accordance with OAR 410-120-1860; and
(b) Make reasonable efforts to give the member prompt oral notice of the denial and follow up within two days with a written notice.
(8) If a member requests an expedited hearing, the Authority shall request documentation from the MCE, and the MCE shall submit relevant documentation including clinical documentation to the Authority within two working days.
Statutory/Other Authority: ORS 413.042 & ORS 414.065
Statutes/Other Implemented: ORS 414.065 & 414.727
History:
DMAP 28-2021, amend filed 06/28/2021, effective 07/01/2021
DMAP 57-2019, adopt filed 12/17/2019, effective 01/01/2020