i_comedicaidcl_2016a_2016-09-29t09:06:44z2 Hearing Summary

Date: 09/29/2016

09:49 AM -- Bill 2 - Review of Legal Sufficiency Of Medicaid Appeals



Brita Darling, OLLS, presented Bill 2 and responded to questions (Attachment E). Bill 2 requires administrative law judges to review the legal sufficiency of Medicaid notices of action when a client appeals a termination or reduction in benefits (adverse action). The legal review of notices will take place at the start of an appeal. If the administrative law judge determines that the notice is not legally sufficient, he or she shall inform the client that the adverse action may be set aside. The client may then ask the administrative law judge to decide the case in his or her favor on the basis of the insufficient notice. Alternately, the client may waive his or her defense on the basis of insufficient notice and request that the appeal proceed to a hearing on the merits of the case. Administrative law judges must inform clients that HCPF may issue a legally sufficient notice in the future and that the client may be required to repay any benefits received, as provided under current law, if the adverse action is upheld after the new notice is issued.



160929 AttachE.pdf



09:52 AM



Bill Zepernick, LCS, presented the fiscal note prepared on Bill 2 and responded to questions (Attachment F).



160929 AttachF.pdf



09:53 AM -- Judge Azer, OAC, discussed the provisions of the bill. He explained that, currently, Medicaid clients need to raise the issue about insufficient notice, but under the bill, the judge is required to review all notices and determine if the notice is valid. Judge Azer responded to questions about the definition of legal sufficiency. He explained that a notice is considered legally sufficiency if it contains seven specific pieces of information, for example, the date of the action, a statement about the reason for the action, and statutory citations. Committee discussion followed about the criteria used to determine sufficient notice and the judicial process involved in an appeal.





10:06 AM -- Jack Regenbogen, Colorado Center on Law and Policy, spoke in favor of Bill 2. He stated that an affirmative defense for an insufficient notice is useless to an appellant that does not know that the option to claim it exists. He stated that, in his opinion, the definition of legally sufficient does include the readability of the document. Mr. Regenbogen responded to questions from the committee.

10:16 AM



Representative Danielson and Senator Crowder will be the prime sponsors for Bill 2.