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§ 6540. Definitions for the Small Business Health Options Program (SHOP) Appeals Process.

10 CA ADC § 6540BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS

Barclays Official California Code of Regulations Currentness
Title 10. Investment
Chapter 12. California Health Benefit Exchange
Article 6. Application, Eligibility, and Enrollment in the Shop Exchange
10 CCR § 6540
§ 6540. Definitions for the Small Business Health Options Program (SHOP) Appeals Process.
In addition to the definitions in Section 6410 of Article 2 of this chapter, for purposes of the SHOP Appeals Process, the following terms shall mean:
Appeal record: The appeal decision, all papers and requests filed in the proceeding, and, if a hearing was held, the transcript or recording of hearing testimony or an official report containing the substance of what happened at the hearing and any exhibits introduced at the hearing.
Appeals Representative: an authorized representative, an agent or broker of the employer, legal counsel, a relative, a friend, an employer filing for its employee or another spokesperson designated by the appellant.
Appeal request: A clear expression, either orally or in writing, by an applicant, enrollee, employer, or employee to have any SHOP eligibility determination reviewed by an appeals entity.
Appeals entity: A body designated to conduct appeals hearings of any SHOP eligibility determinations. The California Department of Social Services shall be the designated appeals entity for the SHOP.
Appellant: The applicant or enrollee, the employer, or employee who is requesting an appeal.
De novo review: A review of an appeal without deference to prior decisions in the case.
Eligibility determination: A determination that an applicant, enrollee, employer, or employee is eligible or not eligible for enrollment in a QHP pursuant to this Article.
Evidentiary hearing: A hearing conducted where evidence may be presented.
Good Cause: Cause as defined in Section 10951(b)(2) of the Welfare and Institutions Code.
Statement of Position: A writing submitted by the Appellant or SHOP that describes the Appellant's or SHOP's position regarding an appeal, as specified in Section 10952.5 of the Welfare and Institution Code.
Vacate: To set aside a previous action.
Note: Authority cited: Section 100504, Government Code. Reference: Section 100506, Government Code; and 45 CFR § 155.740.
HISTORY
1. New section filed 12-3-2013 as an emergency; operative 12-3-2013 (Register 2013, No. 49). A Certificate of Compliance must be transmitted to OAL by 6-2-2014 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 6-2-2014 as an emergency; operative 6-2-2014 (Register 2014, No. 23). A Certificate of Compliance must be transmitted to OAL by 9-2-2014 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 9-2-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-2-2014 (Register 2014, No. 36). A Certificate of Compliance must be transmitted to OAL by 12-3-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
4. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 12-5-2016 or the language in the emergency order of 9-2-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
5. Certificate of Compliance as to 9-2-2014 order, including amendment of definitions of “Eligibility determination” and “Statement of Position,” transmitted to OAL 5-4-2016 and filed 6-14-2016; amendments effective 6-14-2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 25).
This database is current through 5/6/22 Register 2022, No. 18
10 CCR § 6540, 10 CA ADC § 6540
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