Common use of VERIFICATION PROCEDURES AND OPPORTUNITY TO CONTEST FINDINGS Clause in Contracts

VERIFICATION PROCEDURES AND OPPORTUNITY TO CONTEST FINDINGS. The Privacy Act at 5 U.S.C. § 552a(p) requires that each matching agreement specify procedures for verifying information produced in the matching program and for providing affected individuals with an opportunity to contest findings. A. Verification Procedures (1) The AE received information that indicates the individual is ineligible for an IAP; and (2) the Applicant, or Enrollee has a specified number of days from the date of the notice to contest the determination that the Applicant or Enrollee is not eligible for the relevant IAPs. In complying with applicable law, the AE will in no instance take adverse action in fewer than 30 days after Applicant or Enrollee has received notice. B. Opportunity to Contest Findings In the event that information attested to by an individual for matching purposes is inconsistent with information received through electronic verifications obtained by the VHA through the Hub, the individual must be provided notice that the information they submitted did not match information received through electronic verifications as follows: 1. If the AE is an Exchange, an individual seeking to resolve inconsistencies between attestations and the results of electronic verification for the purposes of completing an Eligibility Determination should be provided the opportunity to follow the procedures outlined in 45 CFR §§ 155.315 and 155.320. The AE will provide the proper contact information and instructions to the individual resolving the inconsistency. 2. If the AE is an agency administering a Medicaid or CHIP program, an individual seeking to resolve inconsistencies between attestations and the results of electronic for the purposes of completing an Eligibility Determination should be provided the opportunity to follow the procedures outlined in 42 CFR §§ 435.945 through 435.956. The AE will provide the proper contact information and instructions to the individual resolving the inconsistency. 3. Per 42 CFR § 600.345, if the AE is a BHP, it must elect either the Exchange verification procedures set forth in VI.B.1 or the Medicaid verification procedures set forth at VI.B.2.

VERIFICATION PROCEDURES AND OPPORTUNITY TO CONTEST FINDINGS. ‌‌ The Privacy Act at 5 U.S.C. § 552a(p) requires that each matching agreement specify procedures for verifying information produced in the matching program and for providing affected individuals with an opportunity to contest findings. A. Verification Procedures (1) The AE received information that indicates the individual is ineligible for an IAP; and (2) the Applicant, or Enrollee has a specified number of days from the date of the notice to contest the determination that the Applicant or Enrollee is not eligible for the relevant IAPs. In complying with applicable law, the AE will in no instance take adverse action in fewer than 30 days after Applicant or Enrollee has received notice. B. Opportunity to Contest Findings In the event that information attested to by an individual for matching purposes is inconsistent with information received through electronic verifications obtained by the VHA through the Hub, the individual must be provided notice that the information they submitted did not match information received through electronic verifications as follows: 1. If the AE is an Exchange, an individual seeking to resolve inconsistencies between attestations and the results of electronic verification for the purposes of completing an Eligibility Determination should be provided the opportunity to follow the procedures outlined in 45 CFR §§ 155.315 and 155.320. The AE will provide the proper contact information and instructions to the individual resolving the inconsistency.and 2. If the AE is an agency administering a Medicaid or CHIP program, an individual seeking to resolve inconsistencies between attestations and the results of electronic for the purposes of completing an Eligibility Determination should be provided the opportunity to follow the procedures outlined in 42 CFR §§ 435.945 through 435.956. The AE will provide the proper contact information and instructions to the individual resolving the inconsistency.inconsistency.‌ 3. Per 42 CFR § 600.345, if the AE is a BHP, it must elect either the Exchange verification procedures set forth in VI.B.1 or the Medicaid verification procedures set forth at VI.B.2.