Medicaid appeals in Nevada: hearing deadline and keeping benefits

Medicaid (Nevada Medicaid) denials in Nevada

Medicaid agency

Nevada Health Authority (Nevada Medicaid) for services; Nevada Division of Social Services (DSS) for eligibility

Who holds the hearing

Nevada Medicaid Hearings Unit with a Department of Administration hearing officer (service denials); DSS Administrative Adjudications Unit (eligibility)

Hearing deadline

90 days

The date on the Notice of Decision

Source: counting starts the day after the notice date

If you are late

A late request can be accepted if you can show good cause for missing the deadline.

How to ask for a hearing

• Form: For a denied, reduced, suspended or ended service: Fair Hearing Request Form NMO-6300E to the Nevada Medicaid Hearings Unit, 9850 Double R Blvd, Ste 200, Reno, NV 89521
• Fax: Nevada Medicaid Hearings Unit, 775-684-3610
• Online: Email medicaidhearings@nvha.nv.gov (service hearings); the request can also be made by phone, in person or other electronic means
• Mail: For eligibility decisions by DSS: a written request to the DSS Administrative Adjudications Unit, 500 Amigo Ct. Ste 100, Las Vegas, NV 89119 (phone 702-486-1910, fax 725-205-2153, aau@dss.nv.gov)

www.nevadamedicaid.nv.gov

Mail address

Nevada Medicaid Hearings Unit, 9850 Double R Blvd, Ste 200, Reno, NV 89521

What to include

Your name, address, phone number and Medicaid number, a copy of the Notice of Decision, and, if someone helps you, that person's name, address, phone number and relationship to you. Sign the request. Check the boxes if you want an expedited hearing (attach your provider's medical documentation) or want your services continued.

Keeping your benefits during the appeal

To keep your services the same until the hearing decision, ask for a hearing before the Date of Action on your notice and check the box to continue services. If you ask no more than 10 calendar days after the Date of Action, Nevada Medicaid may reinstate your services; it must reinstate them if it did not send the required advance notice. For eligibility (DSS) cases, the written request must be received by the 10th day after the effective date of the action. If you lose, Medicaid may ask you to pay back the cost of continued services.

Law: Form NMO-6300E (09-26); 42 CFR 431.230-431.231; NRS 422.306

When the hearing is held

Within 10 calendar days of a standard hearing request, Nevada Medicaid offers an optional Hearing Preparation Meeting by phone (held within 21 working days) to try to resolve the issue. You get at least 10 calendar days' notice of the hearing. The decision is due within 90 calendar days of the request.

Faster (expedited) hearing

Check the expedited box on the request form and attach your provider's medical documentation showing that a standard hearing could jeopardize your life, health or ability to attain, maintain or regain maximum function. Expedited hearings are by phone, and the decision is due no later than 3 working days after the Hearings Office receives the request.

Law: NRS 422.306

Medicaid health plan (managed care) in Nevada

Appeal to the plan first

Appeal to your Medicaid health plan (MCO) by phone or in writing within 60 calendar days from the date on the notice of adverse benefit determination. There is only one level of plan appeal. A standard appeal is decided within 30 calendar days (the plan can extend by 14 days). If the plan does not decide fully in your favor, ask for a State Fair Hearing in writing within 90 calendar days from the date of the plan's notice of resolution. To keep services during the plan appeal, ask on or before 10 calendar days after the notice was mailed or the intended effective date, whichever is later.

Then a state hearing

90 days

The date of the MCO's notice of resolution of the appeal

Law: 42 CFR 438.402, 438.408, 438.420

Write my appeal: free letters

Letter: Medicaid fair hearing request