| 1 | 1 | | FIRSTREGULARSESSION |
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| 2 | 2 | | HOUSEBILLNO.1223 |
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| 3 | 3 | | 103RDGENERALASSEMBLY |
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| 4 | 4 | | INTRODUCEDBYREPRESENTATIVEPETERS. |
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| 5 | 5 | | 2278H.01I JOSEPHENGLER,ChiefClerk |
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| 6 | 6 | | ANACT |
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| 7 | 7 | | Torepealsections208.080and208.156,RSMo,andtoenactinlieuthereoftwonewsections |
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| 8 | 8 | | relatingtoadministrativeremediesinMOHealthNetcases. |
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| 9 | 9 | | BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows: |
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| 10 | 10 | | SectionA.Sections208.080and208.156,RSMo,arerepealedandtwonewsections |
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| 11 | 11 | | 2enactedinlieuthereof,tobeknownassections208.080and208.156,toreadasfollows: |
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| 12 | 12 | | 208.080.1.Anyapplicantfororrecipientofbenefitsorservicesprovidedbylawby |
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| 13 | 13 | | 2thefamilysupportdivision,children'sdivision,[or]MOHealthNetdivision, orMissouri |
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| 14 | 14 | | 3Medicaidauditandcomplianceunitmayappealtothedirectoroftherespectivedivisionor |
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| 15 | 15 | | 4unitfromadecisioninanyofthefollowingcases: |
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| 16 | 16 | | 5 (1)Ifhisorherrighttomakeapplicationforanysuchbenefitsorservicesisdenied; |
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| 17 | 17 | | 6or |
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| 18 | 18 | | 7 (2)Ifhisorherapplicationisdisallowedinwholeorinpart,orisnotactedupon |
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| 19 | 19 | | 8withinareasonabletimeafteritisfiled;or |
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| 20 | 20 | | 9 (3)Ifitisproposedtocancelormodifybenefitsorservices;or |
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| 21 | 21 | | 10 (4)Ifheorsheisadverselyaffectedbyanydeterminationofthefamilysupport |
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| 22 | 22 | | 11division,children'sdivision,[or]MOHealthNetdivision, orMissouriMedicaidauditand |
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| 23 | 23 | | 12complianceunitintheadministrationoftheprogramsadministeredbysuchdivisionsor |
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| 24 | 24 | | 13unit;or |
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| 25 | 25 | | 14 (5)Ifadeterminationismadepursuanttosubsection2ofsection208.180that |
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| 26 | 26 | | 15paymentofbenefitsonbehalfofadependentchildshallnotbemadetotherelativewith |
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| 27 | 27 | | 16whomheorshelives. |
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| 28 | 28 | | EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis |
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| 29 | 29 | | intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 2.Ifadivisionorunitproposestoterminateormodifythepaymentofbenefitsorthe |
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| 30 | 30 | | 18providingofservicestotherecipientoradivisionorunithasterminatedormodifiedthe |
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| 31 | 31 | | 19paymentofbenefitsorprovidingofservicestotherecipientandtherecipientappeals,the |
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| 32 | 32 | | 20decisionofthedirectorastotheeligibilityoftherecipientatthetimesuchactionwas |
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| 33 | 33 | | 21proposedortakenshallbebasedonthefactsshownbytheevidencepresentedatthehearing |
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| 34 | 34 | | 22oftheappealtohaveexistedatthetimesuchactiontoterminateormodifywasproposedor |
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| 35 | 35 | | 23wastaken. |
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| 36 | 36 | | 24 3.Inthecaseofaproposedactionbythefamilysupportdivision,children'sdivision, |
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| 37 | 37 | | 25[or]MOHealthNetdivision, orMissouriMedicaidauditandcomplianceunittoreduce, |
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| 38 | 38 | | 26modify,ordiscontinuebenefitsorservicestoarecipient,therecipientofsuchbenefitsor |
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| 39 | 39 | | 27servicesshallhavetendaysfromthedateofthemailingofnoticeoftheproposedactionto |
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| 40 | 40 | | 28reduce,modify,ordiscontinuebenefitsorserviceswithinwhichtorequestanappealtothe |
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| 41 | 41 | | 29directorofthedivisionorunit. Inthenoticetotherecipientofsuchproposedaction,the |
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| 42 | 42 | | 30appropriatedivisionorunitshallnotifytherecipientofallhisorherrightsofappealunder |
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| 43 | 43 | | 31thissection.Properblankformsforappealtothedirectorofthedivisionorunitshallbe |
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| 44 | 44 | | 32furnishedbytheappropriatedivisionorunittoanyaggrievedrecipient.Everysuchappealto |
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| 45 | 45 | | 33thedirectorofthedivisionorunitshallbetransmittedbytheappropriatedivisionorunit |
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| 46 | 46 | | 34immediatelyuponthesamebeingfiledwiththeappropriatedivisionorunit. Ifanappealis |
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| 47 | 47 | | 35requested,benefitsorservicesshallcontinueundiminishedorunchangeduntilsuchappealis |
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| 48 | 48 | | 36heardandadecisionhasbeenrenderedthereon,exceptthatinanaidtofamilieswith |
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| 49 | 49 | | 37dependentchildrencasetherecipientmayrequestthatbenefitsorservicesnotbecontinued |
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| 50 | 50 | | 38undiminishedorunchangedduringtheappeal. |
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| 51 | 51 | | 39 4.Whenacasehasbeenclosedormodifiedandnoappealwasrequestedpriorto |
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| 52 | 52 | | 40closingormodification,therecipientshallhaveninetydaysfromthedateofclosingor |
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| 53 | 53 | | 41modificationtorequestanappealtothedirectorofthedivisionorunit. Eachrecipientwho |
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| 54 | 54 | | 42hasnotrequestedanappealpriortotheclosingormodificationofhisorhercaseshallbe |
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| 55 | 55 | | 43notifiedatthetimeofsuchclosingormodificationofhisorherrighttorequestanappeal |
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| 56 | 56 | | 44duringthisninety-dayperiod.Properblankformsforrequestinganappealtothedirectorof |
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| 57 | 57 | | 45thedivisionorunitshallbefurnishedbytheappropriatedivisionorunittoanyaggrieved |
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| 58 | 58 | | 46applicant.Everysuchrequestmadeinanymannerforanappealtothedirectorofthedivision |
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| 59 | 59 | | 47orunitshallbetransmittedbytheappropriatedivisionorunittothedirectorofthedivision |
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| 60 | 60 | | 48orunitimmediatelyuponthesamebeingfiledwiththeappropriatedivisionorunit. Ifan |
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| 61 | 61 | | 49appealisrequestedintheninety-dayperiodsubsequenttotheclosingormodification, |
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| 62 | 62 | | 50benefitsorservicesshallnotbecontinuedattheirpriorlevelduringthependencyofthe |
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| 63 | 63 | | 51appeal. |
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| 64 | 64 | | 52 5.Inthecaseofarejectionofanapplicationforbenefitsorservices,theaggrieved |
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| 65 | 65 | | 53applicantshallhaveninetydaysfromthedateofthenoticeoftheactioninwhichtorequest |
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| 66 | 66 | | HB1223 2 54anappealtothedirectorofthedivisionorunit. Intherejectionnoticetheapplicantfor |
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| 67 | 67 | | 55benefitsorservicesshallbenotifiedofallofhisorherrightsofappealunderthissection. |
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| 68 | 68 | | 56Properblankformsforrequestinganappealtothedirectorofthedivisionorunitshallbe |
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| 69 | 69 | | 57furnishedbytheappropriatedivisionorunittoanyaggrievedapplicant.Anysuchrequest |
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| 70 | 70 | | 58madeinanymannerforanappealshallbetransmittedbytheappropriatedivisionorunitto |
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| 71 | 71 | | 59thedirectorofthedivisionorunit, immediatelyuponthesamebeingfiledwiththe |
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| 72 | 72 | | 60appropriatedivisionorunit. |
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| 73 | 73 | | 61 6.Ifthedivisionorunithasrejectedanapplicationforbenefitsorservicesandthe |
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| 74 | 74 | | 62applicantappeals,thedecisionofthedirectorastotheeligibilityoftheapplicantatthetime |
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| 75 | 75 | | 63suchrejectionwasmadeshallbebaseduponthefactsshownbytheevidencepresentedatthe |
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| 76 | 76 | | 64hearingoftheappealtohaveexistedatthetimetherejectionwasmade. |
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| 77 | 77 | | 65 7.Thedirectorofthedivisionorunitshallgivetheapplicantforbenefitsorservices |
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| 78 | 78 | | 66ortherecipientofbenefitsorservicesreasonablenoticeof,andanopportunityfor,afair |
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| 79 | 79 | | 67hearinginthecountyofhisorherresidenceatthetimetheadverseactionwastaken.The |
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| 80 | 80 | | 68hearingshallbeconductedbythedirectorofthedivisionorunitorsuchdirector'sdesignee. |
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| 81 | 81 | | 69Everyapplicantorrecipient,onappealtothedirectorofthedivisionorunit,shallbeentitled |
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| 82 | 82 | | 70tobepresentatthehearing,inpersonandbyattorneyorrepresentative,andshallbeentitled |
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| 83 | 83 | | 71tointroduceintotherecordofsuchhearinganyandallevidence,bywitnessesorotherwise, |
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| 84 | 84 | | 72pertinenttosuchapplicant'sorrecipient'seligibilitybetweenthetimeheorsheappliedfor |
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| 85 | 85 | | 73benefitsorservicesandthetimetheapplicationwasdeniedorthebenefitsorserviceswere |
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| 86 | 86 | | 74terminatedormodified,andallsuchevidenceshallbetakendown,preserved,andshall |
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| 87 | 87 | | 75becomeapartoftheapplicant'sorrecipient'sappealrecord.Upontherecordsomade,the |
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| 88 | 88 | | 76directorofthedivisionorunitshalldetermineallquestionspresentedbytheappeal,andshall |
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| 89 | 89 | | 77makesuchdecisionastothegrantingofbenefitsorservicesasinhisorheropinionis |
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| 90 | 90 | | 78justifiedandisinconformitywiththeprovisionsofthelaw.Thedirectorshallclearlystate |
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| 91 | 91 | | 79thereasonsforhisorherdecisionandshallincludeastatementoffindingsoffactand |
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| 92 | 92 | | 80conclusionsoflawpertinenttothequestionsinissue. |
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| 93 | 93 | | 81 8.Allappealrequestsmayinitiallybemadeorallyorinanywrittenform,butallsuch |
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| 94 | 94 | | 82requestsshallbetranscribedonformsfurnishedbythedivisionorunitandsignedbythe |
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| 95 | 95 | | 83aggrievedapplicantorrecipientorhisorherrepresentativepriortothecommencementofthe |
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| 96 | 96 | | 84hearing. |
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| 97 | 97 | | 208.156.1.ThefamilysupportdivisionortheMOHealthNetdivisionshallprovide |
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| 98 | 98 | | 2forgrantinganopportunityforafairhearingundersection208.080toanyapplicantor |
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| 99 | 99 | | 3recipientwhoseclaimformedicalassistanceisdeniedorisnotacteduponwithreasonable |
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| 100 | 100 | | 4promptness. |
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| 101 | 101 | | 5 2.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit |
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| 102 | 102 | | 6paymentsareauthorizedundersection208.152whoseclaimforreimbursementforsuch |
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| 103 | 103 | | HB1223 3 7servicesisdeniedorisnotacteduponwithreasonablepromptnessshallbeentitledtoa |
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| 104 | 104 | | 8hearingbeforetheadministrativehearingcommissionpursuanttotheprovisionsofchapter |
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| 105 | 105 | | 9621. |
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| 106 | 106 | | 10 3.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit |
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| 107 | 107 | | 11paymentsareauthorizedundersection208.152whoisdeniedparticipationinanyprogramor |
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| 108 | 108 | | 12programsestablishedundertheprovisionsofchapter208shallbeentitledtoahearingbefore |
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| 109 | 109 | | 13theadministrativehearingcommissionpursuanttotheprovisionsofchapter621. |
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| 110 | 110 | | 14 4.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit |
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| 111 | 111 | | 15paymentsareauthorizedundersection208.152whoisaggrievedbyanyruleorregulation |
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| 112 | 112 | | 16promulgatedbythedepartmentofsocialservicesoranydivisionorunitthereinshallbe |
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| 113 | 113 | | 17entitledtoahearingbeforetheadministrativehearingcommissionpursuanttotheprovisions |
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| 114 | 114 | | 18ofchapter621. |
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| 115 | 115 | | 19 5.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit |
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| 116 | 116 | | 20paymentsareauthorizedundersection208.152whoisaggrievedbyanyruleorregulation, |
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| 117 | 117 | | 21contractualagreement,ordecision,asprovidedforinsection208.166,bythedepartmentof |
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| 118 | 118 | | 22socialservicesoranydivisionorunitthereinshallbeentitledtoahearingbeforethe |
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| 119 | 119 | | 23administrativehearingcommissionpursuanttotheprovisionsofchapter621. |
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| 120 | 120 | | 24 6.Noproviderofservicemayfileapetitionforahearingbeforetheadministrative |
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| 121 | 121 | | 25hearingcommissionunlesstheamountforwhichheorsheseeksreimbursementexceedsfive |
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| 122 | 122 | | 26hundreddollars. |
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| 123 | 123 | | 27 7.Oneormoreprovidersofserviceaswillfairlyinsureadequaterepresentationof |
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| 124 | 124 | | 28othershavingsimilarclaimsagainstthedepartmentofsocialservicesoranydivisionorunit |
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| 125 | 125 | | 29thereinmayinstitutethehearingonbehalfofallintheclassifthereisacommonquestionof |
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| 126 | 126 | | 30laworfactaffectingtheseveralrightsandacommonreliefissought. |
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| 127 | 127 | | 31 8.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit |
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| 128 | 128 | | 32paymentsareauthorizedundersection208.152andwhoisentitledtoahearingasprovided |
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| 129 | 129 | | 33forintheprecedingsectionsshallhavethirtydaysfromthedateofmailingordeliveryofa |
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| 130 | 130 | | 34decisionofthedepartmentofsocialservicesoritsdesignateddivisionorunitinwhichtofile |
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| 131 | 131 | | 35hisorherpetitionforreviewwiththeadministrativehearingcommissionexceptthatclaims |
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| 132 | 132 | | 36oflessthanfivehundreddollarsmaybeaccumulateduntiltheytotalthatsumandatwhich |
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| 133 | 133 | | 37timetheprovidershallhaveninetydaystofilehisorherpetition. |
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| 134 | 134 | | 38 9.Whenapersonentitledtoahearingasprovidedforinthissectionappliestothe |
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| 135 | 135 | | 39administrativehearingcommissionforastayorderstayingtheactionsofthedepartmentof |
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| 136 | 136 | | 40socialservicesoritsdivisionsorunits, theadministrativehearingcommissionshallnotgrant |
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| 137 | 137 | | 41suchstayorderuntilafterafullhearingonsuchapplication.Theapplicationshallbe |
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| 138 | 138 | | 42advancedonthedocketforimmediatehearinganddetermination.Thepersonapplyingfor |
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| 139 | 139 | | 43suchstayordershallnotbegrantedsuchstayorderunlessthatpersonshallshowthat |
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| 140 | 140 | | HB1223 4 44immediateandirreparableinjury,loss,ordamagewillresultifsuchstayorderisdenied,or |
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| 141 | 141 | | 45thatsuchpersonhasareasonablelikelihoodofsuccessuponthemeritsofhisorherclaim; |
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| 142 | 142 | | 46andprovidedfurtherthatnostayordershallbeissuedwithoutthepersonseekingsuchorder |
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| 143 | 143 | | 47postingabondinsuchsumastheadministrativehearingcommissionfindssufficientto |
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| 144 | 144 | | 48protectandpreservetheinterestofthedepartmentofsocialservicesoritsdivisionsorunits. |
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| 145 | 145 | | 49[Innoeventmaytheadministrativehearingcommissiongrantsuchstayorderwherethe |
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| 146 | 146 | | 50claimarisesunderaprogramorprogramsfundedbyfederalfundsorbyanycombinationof |
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| 147 | 147 | | 51stateandfederalfunds,unlessitisspecifiedinwritingbythefinancialsectionofthe |
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| 148 | 148 | | 52appropriatefederalagencythatfederalfinancialparticipationwillbecontinuedunderthestay |
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| 149 | 149 | | 53order.] |
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| 150 | 150 | | 54 10.Theotherprovisionsofthissectionnotwithstanding,apersonreceivingor |
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| 151 | 151 | | 55providingbenefitsshallhavetherighttobringanactioninappealingfromtheadministrative |
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| 152 | 152 | | 56hearingcommissioninthecircuitcourtofColeCounty,Missouri,orthecountyofhisorher |
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| 153 | 153 | | 57residencepursuanttosection536.050. |
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| 154 | 154 | | âś” |
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| 155 | 155 | | HB1223 5 |
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