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Issues for Hearing

The fair hearing or the appeal from agency review must give the applicant a de novo hearing if requested. 42 C.F.R. § 431.232(c). A de novo hearing means it starts over from the beginning. 42 C.F.R. § 431.201. The hearing includes consideration of the following:

1. Any agency action, including the following:

a. Denial or approval of an application;
b. Calculation of patient liability or cost share;
c. Termination of benefits;
d. Change in COA;
e. Change in patient liability or cost share;

2. The agency’s delay in action or failure to act, including:

a. Delay in application processing;
b. Failure to act, or delay in action on a change.

ABD Manual, Appendix B-4; 42 C.F.R. § 431.241.

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