Provider State Fair Hearing

State fair hearing is defined as an administrative hearing involving the presentation of evidence and argument before a presiding officer from the Kansas Office of Administrative Hearings concerning an adverse benefit determination or an action. The presiding officer will hear the matter, determine the result, and issue a decision.

The provider or provider’s authorized representative’s state fair hearing request must be submitted in writing. 

Providers - Request for Medicaid Fair Hearing

• To submit a managed care state fair hearing by fax send to:

  (785) 296-4848 (Requests greater than 20 pages cannot be faxed).

• To submit a managed care state fair hearing by mail send to:
  Office of Administrative Hearings
  1020 S. Kansas Ave.
  Topeka, KS 66612

Yes, the provider or provider’s representative must submit a request for a state fair hearing within 123 calendar days from the date of the notice of the appeal resolution determination.

As of 1-1-20 the provider will have another opportunity to submit a request for a state fair hearing within 33 calendar days of the date of the notice containing the decision by the external independent third-party reviewer.

The MCO will prepare the agency summary including notification to the provider that both the MCO and the Medicaid agency will be appearing at the state fair hearing.

The MCO will send the agency summary and addendums to the provider.

The Office of Administrative Hearings is responsible for the state fair hearing. The administrative hearing judge will usually issue his or her decision within 30 calendar days of the date of the hearing.

The Medicaid Agency is a party to the state fair hearing. The agency will be designated as the respondent in a state fair hearing for cases involving MCO decisions appealed to a state fair hearing by a provider. The Medicaid agency or another State agency authorized to administer that portion of the Kansas Medicaid Program will be designated as the respondent in those cases involving their area of administrative delegation.

The respondent or appellant to the state fair hearing may appeal the decision of the Initial Order issued by the Presiding Officer to the State Appeals Committee (SAC). SAC will review the Initial Order and issue a Final Order.

• If neither the respondent nor appellant requests a review of the Initial Order by SAC, the Initial Order will become the Final Order.
• The respondent or appellant may Appeal the Final Order to a district court.
• The respondent or appellant may also request a Reconsideration of the Final Order by the Secretary of KDHE-DHCF. There are filing time limits that are strictly enforced. The Initial and Final Order specify those time limits.

Send in your state fair hearing request form as soon as possible saying you want a hearing. Provide an explanation of why the decision/final action is unsatisfactory in your circumstances. Include a copy of the “notice” letter.

You may have an attorney represent you at the hearing. The attorney will be at your expense. If you hire an attorney, he or she must be licensed in the State of Kansas and enter their appearance on your behalf prior to the hearing.

• Deadlines for this information will come by letter from the Office of Administrative Hearings.

• To submit a FFS state fair hearing by fax sent to:

  (785) 296-4848 (Requests greater than 20 pages cannot be faxed).

• To submit a FFS state fair hearing by mail sent to:
  Office of Administrative Hearings
  1020 S. Kansas Ave.
  Topeka, KS 66612

Yes, the FFS state fair hearing request must be filed within 33 calendar days from the date on the notice of action.

• The contractor will prepare the agency summary including notification to the provider that both the contractor and the Medicaid agency will be appearing at the state fair hearing.
• The contractor will send the agency summary and addendums to the provider.
• The Office of Administrative Hearings is responsible for the state fair hearing. The administrative hearing judge will usually issue his or her decision within 30 calendar days of the date of the hearing.
• The Medicaid agency is a party to the state fair hearing. The Medicaid agency shall be designated as the Respondent in a state fair hearing for cases involving contractor decisions appealed to a state fair hearing by a provider. The Medicaid agency or another State agency authorized to administer that portion of the Kansas Medicaid Program will be designated as the Respondent in those cases involving their area of administrative delegation.
• The Respondent or Appellant to the state fair hearing may appeal the decision of the Initial Order issued by the Presiding Officer to the State Appeals Committee (SAC). SAC will review the Initial Order and issue a Final Order.
  • If neither the Respondent or Appellant requests a review of the Initial Orders by SAC, the Initial Order will become the Final Order.
  • The Respondent or Appellant may Appeal the Final Order to a district court.
  • The Respondent or Appellant also may request a Reconsideration of the Final Order by the Secretary of KDHE-DHCF. There are filing time limits that are strictly enforced. The Initial and Final Order specify those time limits.

Send in your state fair hearing request form as soon as possible saying you want a hearing. Provide an explanation of why the decision/final action is unsatisfactory in your circumstances. Include a copy of the “notice” letter.

You may have an attorney represent you at the hearing. The attorney will be at your expense. If you hire an attorney, he or she must be licensed in the State of Kansas and enter their appearance on your behalf prior to the hearing.

• Deadlines for this information will come by letter from the Office of Administrative Hearings.