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In May 2016, the Department of Health and Human Services (“HHS”), Centers for Medicare & Medicaid Services (“CMS”) promulgated regulations outlining new procedural requirements for managed care plans’ grievance and appeal systems.
This document provides guidance on how States can, in the process of implementing the new federal regulations, ensure that people with disabilities have equal access to the grievance and appeal and State fair hearing systems, as mandated by Section 504 of the Rehabilitation Act (“Rehab Act”), the Americans with Disabilities Act (“ADA”), and Section 1557 of the Affordable Care Act (“ACA”). It provides advocates with an outline of potentially problematic areas in the appeals process and provides suggested language for the content of State.