Hearings Manual

0130.020.100.20 Hearing Overturns Quality Control Decision

If a hearing decision is received on the same case action that caused a Quality Control error, staff review the decision to determine if the hearing decision reverses the Quality Control decision.

If the Quality Control decision on a MO HealthNet case is reversed, staff notify the Quality Control Unit Manager and send a copy to the Income Maintenance Deputy Director. The Quality Control Unit manager notifies Centers for Medicare & Medicaid Services (CMS) in writing and requests that the findings be changed. The CMS will change findings when it is determined the Quality Control decision is reversed by the hearing.