Connector releases extensive Administrative Bulletin

The Connector's May 31 Administrative Bulletin outlines procedures for waivers, appeals and health plan changes. It also clarifies enrollment and eligibility information for Commonwealth Care. The following addresses the appeals process.

Commonwealth Care members have the right to appeal certain actions, including:

• adverse eligibility decisions
• some terminations
• disenrollment
• denial of a financial hardship waiver

The Connector's Appeals Request Forms must be used. They are available from the Commonwealth Care Customer Service Center at 1-877-MA-ENROLL (1-877-623-6765, TTY: 1-877-623-7773), and contain instructions for filing and pursuing an appeal.

Requests for appeals follow a specific timeline:

• Appeals must be received within 30 days after receipt of written notice of an appealable action
• or 120 days from the date of the appealable action if MassHealth or the Connector fails to send written notice of the action
• 120 days from the date of an application or request if MassHealth or the Connector fails to act on the application or request.

Those requesting appeals must continue to pay premiums and/or co-payments while the appeal is pending. Anyone requesting an appeal may ask to designate someone as his/her representative by submitting a 'Representative Form' provided by the Connector.

Click here for the regulation covering appealable actions (PDF)
Click here for the Appeals Request Form (PDF)
Click here for the Representative Form (PDF)
Click here to be linked to the 18-page Administrative Bulletin