Appeal And Hearing Request Page 3
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4Appeal and Hearing Information
Should I ask for an Appeal or Hearing?
If you disagree with our decision, you have a right to ask us to change it through the Appeal and Hearing process.
The choice to request an Appeal and/or Hearing is yours. The Hearing, if requested, will be conducted according to
the Administrative Procedures Act, ORS Chapter 183, and Oregon Administrative Rules 137-003-0501 to 0700,
410-120-1860, 410-141-0264, 410-141-3264.
What happens if I ask for:
An Appeal -- A nurse or doctor from your CCO or Plan will review your service request and the original
decision. They will use this information to decide if the initial decision should be changed or not changed.
Your CCO or Plan will tell you of their decision within 16 days of your Appeal request by sending you a
Notice of Appeal Resolution.
A Hearing -- At a Hearing, you will have a chance to explain to an Administrative Law Judge why you
disagree with the decision. The following people will participate in the Hearing with you: a DMAP
Hearings Representative, someone from your CCO or Plan, your representative or helper (if you have one),
an Administrative Law Judge and any witnesses you invite. The Judge will make a decision based on the
information presented at the Hearing and tell you their decision within 30 days. Before the Hearing, a
DMAP staff member will call you to get more information and explain what will happen during the
Hearing. If you request a Hearing, you will be notified of the time and place.
If you ask for both an Appeal and Hearing, the Appeal will happen first. If the Appeal changes the original
decision, a Hearing will not be held. If the Appeal does not change the original decision, the Hearing will be
scheduled.
How to request an Appeal and/or Hearing:
You can request an Appeal by:
Completing and mailing the first page of this form to your CCO or Plan, or
Contacting your CCO or Plan by phone, letter or fax. Requests made by phone must be followed up in writing.
You can request a Hearing by:
Completing and mailing pages 1 and 2 of this form to OHA-DMAP or returning it to any DHS office, or
Completing the Administrative Hearings Request Form (MSC 443). You can get a MSC 443 and help filling it
out from any DHS office or by calling OHP Customer Service at 1-800-699-9075 (TTY 711). Mail the MSC
443 to OHA-DMAP or return it to any DHS office.
Deadline
Requests for both Appeals and Administrative Hearings must be received within 45 days of the Date of Notice
shown on the first page of the Notice of Action or Notice of Appeal Resolution.
Note: If you want to keep getting services, see the Continuing Services section of this form for more information
Note to military personnel: Active duty service members have a right to stay (delay) these proceedings under
the federal Servicemembers Civil Relief Act (SCRA). For more information, you may contact the Oregon State
Bar at 1-800-452-8260, the Oregon Military Department at 1-800-452-7500 or the nearest legal assistance
office.
Help with an Appeal or Administrative Hearing
Call any of the following if you need help with your Appeal or Hearing:
Customer Service – see the Questions section of the Notice of Action.
The Public Benefits Hotline at 1-800-520-5292 (TTY 711).
DMAP 3302 (Rev 1/2014)
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