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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1568
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR CARTER.
6718S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 208.080 and 208.156, RSMo, and to enact in lieu thereof two new sections
relating to administrative remedies in MO HealthNet cases.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 208.080 and 208.156, RSMo, are 1
repealed and two new sections enacted in lieu thereof, to be 2
known as sections 208.080 and 208.156, to read as follows:3
208.080. 1. Any applicant for or recipient of 1
benefits or services provided by law by the family support 2
division, children's division, [or] MO HealthNet division, 3
or Missouri Medicaid audit and compliance unit may appeal to 4
the director of the respective division or unit from a 5
decision in any of the following cases: 6
(1) If his or her right to make application for any 7
such benefits or services is denied; or 8
(2) If his or her application is disallowed in whole 9
or in part, or is not acted upon within a reasonable time 10
after it is filed; or 11
(3) If it is proposed to cancel or modify benefits or 12
services; or 13
(4) If he or she is adversely affected by any 14
determination of the family support division, children's 15
division, [or] MO HealthNet division, or Missouri Medicaid 16
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audit and compliance unit in the administration of the 17
programs administered by such divisions or unit; or 18
(5) If a determination is made pursuant to subsection 19
2 of section 208.180 that payment of benefits on behalf of a 20
dependent child shall not be made to the relative with whom 21
he or she lives. 22
2. If a division or unit proposes to terminate or 23
modify the payment of benefits or the providing of services 24
to the recipient or a division or unit has terminated or 25
modified the payment of benefits or providing of services to 26
the recipient and the recipient appeals, the decision of the 27
director as to the eligibility of the recipient at the time 28
such action was proposed or taken shall be based on the 29
facts shown by the evidence presented at the hearing of the 30
appeal to have existed at the time such action to terminate 31
or modify was proposed or was taken. 32
3. In the case of a proposed action by the family 33
support division, children's division, [or] MO HealthNet 34
division, or Missouri Medicaid audit and compliance unit to 35
reduce, modify, or discontinue benefits or services to a 36
recipient, the recipient of such benefits or services shall 37
have ten days from the date of the mailing of notice of the 38
proposed action to reduce, modify, or discontinue benefits 39
or services within which to request an appeal to the 40
director of the division or unit. In the notice to the 41
recipient of such proposed action, the appropriate division 42
or unit shall notify the recipient of all his or her rights 43
of appeal under this section. Proper blank forms for appeal 44
to the director of the division or unit shall be furnished 45
by the appropriate division or unit to any aggrieved 46
recipient. Every such appeal to the director of the 47
division or unit shall be transmitted by the appropriate 48
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division or unit immediately upon the same being filed with 49
the appropriate division or unit. If an appeal is 50
requested, benefits or services shall continue undiminished 51
or unchanged until such appeal is heard and a decision has 52
been rendered thereon, except that in an aid to families 53
with dependent children case the recipient may request that 54
benefits or services not be continued undiminished or 55
unchanged during the appeal. 56
4. When a case has been closed or modified and no 57
appeal was requested prior to closing or modification, the 58
recipient shall have ninety days from the date of closing or 59
modification to request an appeal to the director of the 60
division or unit. Each recipient who has not requested an 61
appeal prior to the closing or modification of his or her 62
case shall be notified at the time of such closing or 63
modification of his or her right to request an appeal during 64
this ninety-day period. Proper blank forms for requesting 65
an appeal to the director of the division or unit shall be 66
furnished by the appropriate division or unit to any 67
aggrieved applicant. Every such request made in any manner 68
for an appeal to the director of the division or unit shall 69
be transmitted by the appropriate division or unit to the 70
director of the division or unit immediately upon the same 71
being filed with the appropriate division or unit. If an 72
appeal is requested in the ninety-day period subsequent to 73
the closing or modification, benefits or services shall not 74
be continued at their prior level during the pendency of the 75
appeal. 76
5. In the case of a rejection of an application for 77
benefits or services, the aggrieved applicant shall have 78
ninety days from the date of the notice of the action in 79
which to request an appeal to the director of the division 80
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or unit. In the rejection notice the applicant for benefits 81
or services shall be notified of all of his or her rights of 82
appeal under this section. Proper blank forms for 83
requesting an appeal to the director of the division or unit 84
shall be furnished by the appropriate division or unit to 85
any aggrieved applicant. Any such request made in any 86
manner for an appeal shall be transmitted by the appropriate 87
division or unit to the director of the division or unit, 88
immediately upon the same being filed with the appropriate 89
division or unit. 90
6. If the division or unit has rejected an application 91
for benefits or services and the applicant appeals, the 92
decision of the director as to the eligibility of the 93
applicant at the time such rejection was made shall be based 94
upon the facts shown by the evidence presented at the 95
hearing of the appeal to have existed at the time the 96
rejection was made. 97
7. The director of the division or unit shall give the 98
applicant for benefits or services or the recipient of 99
benefits or services reasonable notice of, and an 100
opportunity for, a fair hearing in the county of his or her 101
residence at the time the adverse action was taken. The 102
hearing shall be conducted by the director of the division 103
or unit or such director's designee. Every applicant or 104
recipient, on appeal to the director of the division or 105
unit, shall be entitled to be present at the hearing, in 106
person and by attorney or representative, and shall be 107
entitled to introduce into the record of such hearing any 108
and all evidence, by witnesses or otherwise, pertinent to 109
such applicant's or recipient's eligibility between the time 110
he or she applied for benefits or services and the time the 111
application was denied or the benefits or services were 112
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terminated or modified, and all such evidence shall be taken 113
down, preserved, and shall become a part of the applicant's 114
or recipient's appeal record. Upon the record so made, the 115
director of the division or unit shall determine all 116
questions presented by the appeal, and shall make such 117
decision as to the granting of benefits or services as in 118
his or her opinion is justified and is in conformity with 119
the provisions of the law. The director shall clearly state 120
the reasons for his or her decision and shall include a 121
statement of findings of fact and conclusions of law 122
pertinent to the questions in issue. 123
8. All appeal requests may initially be made orally or 124
in any written form, but all such requests shall be 125
transcribed on forms furnished by the division or unit and 126
signed by the aggrieved applicant or recipient or his or her 127
representative prior to the commencement of the hearing. 128
208.156. 1. The family support division or the MO 1
HealthNet division shall provide for granting an opportunity 2
for a fair hearing under section 208.080 to any applicant or 3
recipient whose claim for medical assistance is denied or is 4
not acted upon with reasonable promptness. 5
2. Any person authorized under section 208.153 to 6
provide services for which benefit payments are authorized 7
under section 208.152 whose claim for reimbursement for such 8
services is denied or is not acted upon with reasonable 9
promptness shall be entitled to a hearing before the 10
administrative hearing commission pursuant to the provisions 11
of chapter 621. 12
3. Any person authorized under section 208.153 to 13
provide services for which benefit payments are authorized 14
under section 208.152 who is denied participation in any 15
program or programs established under the provisions of 16
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chapter 208 shall be entitled to a hearing before the 17
administrative hearing commission pursuant to the provisions 18
of chapter 621. 19
4. Any person authorized under section 208.153 to 20
provide services for which benefit payments are authorized 21
under section 208.152 who is aggrieved by any rule or 22
regulation promulgated by the department of social services 23
or any division or unit therein shall be entitled to a 24
hearing before the administrative hearing commission 25
pursuant to the provisions of chapter 621. 26
5. Any person authorized under section 208.153 to 27
provide services for which benefit payments are authorized 28
under section 208.152 who is aggrieved by any rule or 29
regulation, contractual agreement, or decision, as provided 30
for in section 208.166, by the department of social services 31
or any division or unit therein shall be entitled to a 32
hearing before the administrative hearing commission 33
pursuant to the provisions of chapter 621. 34
6. No provider of service may file a petition for a 35
hearing before the administrative hearing commission unless 36
the amount for which he or she seeks reimbursement exceeds 37
five hundred dollars. 38
7. One or more providers of service as will fairly 39
insure adequate representation of others having similar 40
claims against the department of social services or any 41
division or unit therein may institute the hearing on behalf 42
of all in the class if there is a common question of law or 43
fact affecting the several rights and a common relief is 44
sought. 45
8. Any person authorized under section 208.153 to 46
provide services for which benefit payments are authorized 47
under section 208.152 and who is entitled to a hearing as 48
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provided for in the preceding sections shall have thirty 49
days from the date of mailing or delivery of a decision of 50
the department of social services or its designated division 51
or unit in which to file his or her petition for review with 52
the administrative hearing commission except that claims of 53
less than five hundred dollars may be accumulated until they 54
total that sum and at which time the provider shall have 55
ninety days to file his or her petition. 56
9. When a person entitled to a hearing as provided for 57
in this section applies to the administrative hearing 58
commission for a stay order staying the actions of the 59
department of social services or its divisions or units, the 60
administrative hearing commission shall not grant such stay 61
order until after a full hearing on such application. The 62
application shall be advanced on the docket for immediate 63
hearing and determination. The person applying for such 64
stay order shall not be granted such stay order unless that 65
person shall show that immediate and irreparable injury, 66
loss, or damage will result if such stay order is denied, or 67
that such person has a reasonable likelihood of success upon 68
the merits of his or her claim; and provided further that no 69
stay order shall be issued without the person seeking such 70
order posting a bond in such sum as the administrative 71
hearing commission finds sufficient to protect and preserve 72
the interest of the department of social services or its 73
divisions or units. [In no event may the administrative 74
hearing commission grant such stay order where the claim 75
arises under a program or programs funded by federal funds 76
or by any combination of state and federal funds, unless it 77
is specified in writing by the financial section of the 78
appropriate federal agency that federal financial 79
participation will be continued under the stay order.] 80
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10. The other provisions of this section 81
notwithstanding, a person receiving or providing benefits 82
shall have the right to bring an action in appealing from 83
the administrative hearing commission in the circuit court 84
of Cole County, Missouri, or the county of his or her 85
residence pursuant to section 536.050. 86
✓