Appendix B Appeal | Medicaid
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Georgia Division of Family and Children Services |
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Policy Title: |
Appeal |
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Effective Date: |
July 2024 |
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Chapter: |
Appendix B |
Policy Number: |
N/A |
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Previous Policy Number(s): |
MT 60 |
Updated or Reviewed in MT: |
MT-72 |
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Requirements
Both the A/R and DHS/DFCS have the right to request a judicial review of a hearing decision.
Basic Considerations
Effective May 8, 2018, in accordance with O.C.G.A. Section 50-13-41(c), every decision by an OSAH ALJ is a final decision that may only be appealed by filing a petition for judicial review, with proper service in accordance with the applicable law, in the Fulton County Superior Court or in the Superior Court in the county of residence of the petitioner.
Appeals of the Final Hearing Decision
The A/R, AREP, or the agency has the right to appeal the final OSAH hearing decision. The internal process for the agency to request an appeal is outlined below.
Agency Appeal of the Final Hearing Decision
Clearance from the DFCS Medicaid Policy Unit should be obtained to ensure the appeal request meets the hearing criteria before submitting its request for an appeal. If an appeal is warranted, the County Request for a Final Appeal, Form 136 and supporting documentation should be sent to the Fair Hearing Coordinator Supervisor who will email all documents to the DFCS Office of General Counsel (OGC). The OGC will review to determine the validity of the appeal and submit all approved requests for appeal to the Office of Attorney General to request that a civil action be commenced by the filing of a petition for judicial review in the appropriate Superior Court.
| A party has 30 days after service of the final decision to file a petition for judicial review. Service of the final decision is defined as the date the final decision was mailed, i.e., the date of the postmark or the date of the email (if delivered electronically). If staff request an appeal of a final decision, the request must be submitted to OGC within 10 calendar days of the date the final decision was mailed/postmarked/emailed from OSAH (and if such time has expired, submit immediately). |
Because the petition for judicial review must be filed in the appropriate Superior Court within 30 days after service of the final decision, timely notification to the OGC is essential.
The designated reviewing authority reviews the final hearing decision, all related materials, renders a final decision, and notifies all parties of the final decision.
Applicant/Recipient Appeal of the Final Hearing Decision
The A/R or his/her authorized representative has the right to the following:
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appeal an initial decision within thirty (30) days from receipt of the decision
The A/R has the right to request continuation of Medicaid benefits pending a final appeal decision, provided the request for continuation is received within 14 days of the date of the initial hearing decision. For continuation of benefits, refer to Chart B.2 CONTINUATION OF MEDICAL ASSISTANCE PENDING AN APPEAL OF A FINAL HEARING DECISION.
| The Department of Community Health (DCH) reserves the right to require the A/R to repay continued benefits if s/he loses the hearing. |
Procedures
Processing a Final Appeal
Follow the steps below if the A/R or the county DFCS office requests an appeal of the final hearing decision:
Client Appeal - If DFCS receives a Petition for Judicial Review from the A/R or his/her authorized representative, the employee receiving such Petition must immediately email a copy of the Petition to the DFCS OGC.
Agency Appeal - Clearance from the DFCS Medicaid Policy Unit should be obtained to ensure the appeal request meets the hearing criteria before submitting appeal. If an appeal is warranted, Form 136 and supporting documentation should be sent to the Fair Hearing Coordinator Supervisor who will e-mail all documents to OGC. OGC will review to determine validity of appeal and submit to the Special Assistant Attorney General (SAAG) for filing in Superior Court. Petition must be filed in appropriate court within 30 days after service of the final decision. A courtesy copy of the petition will be sent to Department of Community Health.
Client & Agency Appeal - Superior Court reviews the A/R’s Appeal, renders a decision and notifies all parties (A/R, DFCS). Note that there are instances where a Petition may be withdrawn.