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FAQ: Consumer rights and complaints Other client FAQs: Benefits • Enrollment • Rights • Premiums • CopaymentsAre there federal rules about my right to a hearing? Will I have appeal rights if I am disenrolled from a managed care plan? Do my managed care plans address my complaints about copayment amounts (OHP Plus and OHP with Limited Drug only)? Q. Are there federal rules about my right to a hearing? A. Yes. The Code of Federal Regulations (CFR) governs hearing rights. 42 CFR 431.220(b) says we need not grant a hearing when the only issue is a federal or state law that requires an automatic change that adversely affects some or all recipients. Back to top Q. Will I have appeal rights when I am disenrolled from a managed care plan? A. Yes. Our rules list the conditions for disenrollment. Your managed care plan must meet them before we will approve its request. (See OAR 410-141-0080). To get a hearing, you must complete the Request for Administrative Hearing form. You must submit this form within 45 calendar days of date on the client notice. Back to top Q. Do my managed care plans address my complaints about copayment amounts? (OHP Plus and OHP with Limited Drug only) A. We expect your managed care plan to address your complaints under certain conditions. We do not require it when your complaint issue is not eligible for a contested case hearing. We require your managed care plan to have complaint procedures and processes. Our rules spell out these requirements. (See OAR 410-141-0260 through OAR 410-141-0264.) Your appeals are also governed by our rules. (See OAR 410-120-1860.) Back to top This page updated Sept. 2006. |
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