9 NYCRR Part 9700 - Executive Department

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Source version current through May 15, 2022

All 3 displayed sections in this Part carry the same compiled date. Status and warnings stay on each section.

9 NYCRR 9700.1 - General

Later State Register activity may affect this section.

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Dates and status

NYCRR title agency: Executive Department
Section status: Section source receipt
Source version current through: May 15, 2022

(a)These regulations govern the fair hearing process for applicants for coverage under and participation in the Program for Elderly Pharmaceutical Insurance Coverage and establish the rights and obligations of those applicants, participants and the contractor.

(b)The State Department of Health will consider all appeals from the contractor's written decisions after reconsideration on the basis of the eligibility requirements of the program and the reasonable application of discretionary judgments properly exercised by the contractor.

9 NYCRR 9700.2 - Applicants/participants

Later State Register activity may affect this section.

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Dates and status

NYCRR title agency: Executive Department
Section status: Section source receipt
Source version current through: May 15, 2022

For applicants and participants, these regulations govern the following:

(a)Notice.

These regulations set forth what information applicants and participants are entitled to receive with the notice of determination after reconsideration, if coverage has been refused or if there is to be a change in the coverage which the participant has been receiving.

(b)Timing.

These regulations set forth the time periods within which applicants and participants are obligated to request a fair hearing after a written determination after reconsideration by the contractor.

(c)Procedures.

These regulations set forth what applicants and participants are required to do to have a determination after reconsideration reviewed when you are refused coverage or there is a change in the coverage which you are receiving; how to request another hearing date if you are unable to go to the fair hearing on the day it is to be held; how to get an interpreter if you do not speak English or if you are deaf; and who may come with you to a fair hearing.

(d)Decision.

These regulations set forth what you should do if the contractor refuses to comply with the fair hearing decision.

9 NYCRR 9700.3 - Contractor

Later State Register activity may affect this section.

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Dates and status

NYCRR title agency: Executive Department
Section status: Section source receipt
Source version current through: May 15, 2022

For the contractor, these regulations govern the following:

(a)notices to be sent to applicants and participants under the program;

(b)information and documents to be provided to applicants/participants, or their representatives, who have requested a fair hearing;

(c)the fair hearing process; and

(d)compliance with fair hearing decisions.

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