---
kind: "section"
citation: "42 C.F.R. § 600.335"
title: "42"
number: "600.335"
heading: "Appeals."
url: "https://uscodex.org/cfr/42/600.335"
---

# §600.335. Appeals.

- (a) **Notice of eligibility appeal rights.** Eligibility determinations must include a notice of the right to appeal the determination, and instructions regarding how to file an appeal.
- (b) **Appeals process.** Individuals must be given the opportunity to appeal the following actions through the appeals rules of the State's Medicaid program, unless granted an exception under [paragraph (c)](#c) of this section:
  - (1) BHP eligibility determinations; and
  - (2) Delay, denial, reduction, suspension, or termination of health services, in whole or in part, including a determination about the type or level of service, after individuals exhaust appeals or grievances through the BHP standard health plans.
- (c) **Exception.** Subject to HHS approval, a state may request to follow an appeals process for BHP eligibility determinations and health service matters that differs from the State's Medicaid program. In its request, the State must provide a clear description of the responsibilities and functions delegated to such an entity and ensure that:
  - (1) The State has oversight of any entity delegated the authority to administer appeals;
  - (2) The agency to which eligibility determinations or appeals decisions are delegated complies with all relevant Federal and State law, regulations and policies; and
  - (3) The agency to which eligibility determinations or appeals decisions are delegated informs applicants and beneficiaries how they can directly contact and obtain information from the agency.
- (d) **Accessibility.** Notices must be provided and the appeals process must be conducted in a manner accessible to individuals with limited English proficiency and persons with disabilities.

## Notes

### Amendments

[79 FR 14140, Mar. 12, 2014, as amended at 88 FR 79555, Nov. 16, 2023]

### Authority

Authority: 42 U.S.C. 300gg, 1395, and 18051.

### Source

Source: 79 FR 14140, Mar. 12, 2014, unless otherwise noted.

### Amendments

[79 FR 14140, Mar. 12, 2014, as amended at 88 FR 79555, Nov. 16, 2023]