42 C.F.R. § 431.246
Corrective action
The agency must promptly make corrective payments, retroactive to the date an incorrect action was taken, and, if appropriate, provide for admission or readmission of an individual to a facility if—
(a) The hearing decision is favorable to the applicant or beneficiary; or
(b) The agency decides in the applicant's or beneficiary's favor before the hearing.
Notes of Decisions
Cited in 29
cases (5 in the last 5 years), 1983–2026 · leading case: Bruce Anderson v. Michael Wilkening, 930 F.3d 1066 (9th Cir. 2019).
Bruce Anderson v. Michael Wilkening, 930 F.3d 1066 (9th Cir. 2019). “the hearing decision is favorable to the applicant or beneficiary,” 42 C.F.R. § 431.246 (a), is fully consistent with the understanding of the right to “appeal” we have derived from the statutory language and context—that the right to an appeal to which there is a right under…”
French v. Dep't of Child. & Families, 920 So. 2d 671 (Fla. 5th DCA 2006). “42 C.F.R. § 431.246 (2004) On appeal, French argues that the trial court erred by failing to order retroactive payments, as required under 42 C.”
Lisnitzer v. Zucker, 983 F.3d 578 (2d Cir. 2020). “and, if appropriate, provide for admission or 13 readmission of an individual to a [medical] facility,” 42 C.F.R. § 431.246 , if a 14 “hearing decision is favorable to the applicant or beneficiary,” § 431.”
Salazar v. Dist. of Columbia, 954 F. Supp. 278 (D.D.C. 1996). “See 42 C.F.R. § 431.246 (1995) (“[t]he agency must promptly make corrective payments, retroactive to the date an incorrect action was taken .”
Shakhnes Ex Rel. Shakhnes v. Berlin, 689 F.3d 244 (2d Cir. 2012). “See 42 C.F.R. § 431.246 (stating that Defendants must provide retroactive benefits and provide for the admission to medical facilities if hearing decisions so require).”
Greenstein, Ex Rel. Horowitz v. Bane, 833 F. Supp. 1054 (S.D.N.Y. 1993). “1 In particular, plaintiffs allege that defendants misinterpret 42 C.F.R. § 431.246 (the “corrective action regulation”) by adopting a policy of not providing full reimbursement for expenses incurred on account of erroneous denials and delays in Medicaid payments and by limiting…”
Grier v. Goetz, 402 F. Supp. 2d 876 (M.D. Tenn. 2005). “Finally, in the context of both prior authorization and benefit limits, if the enroll-ee ultimately prevails on the appeal and is found to have been eligible to have received the services, the State or its contractor shall make corrective payments, retroactive to the date that…”
Conlan v. Bonta', 125 Cal. Rptr. 2d 788 (Cal. Ct. App. 2002). “1061 ), and the corrective action regulation requires the agency to “promptly make corrective payments, retroactive to the date an incorrect action was taken” if it is ultimately determined that the agency incorrectly denied coverage ( 42 C.F.R. §431.246 (2001)). The corrective…”
Schott v. Olszewski, 401 F.3d 682 (6th Cir. 2005). “42 C.F.R. § 431.246 . Underlying this exception is the desire to correct the inequitable consequences of an erroneous denial of eligibility.”
Gomolisky v. Davis, 716 N.E.2d 970 (Ind. Ct. App. 1999). “While we note that Medicaid benefits cease if a hearing decision in favor of the applicant is reversed on agency review, under Indiana’s hearing system that applicant may seek judicial review. Ind. Admin. Code tit.”
Cutler v. Perales, 128 F.R.D. 39 (S.D.N.Y. 1989). “Under 42 C.F.R. 431.246 and 45 C.F.R. 205.10(a)(18), a state must make corrective monetary payments promptly in response to a DAFH favorable to the recipient.”
Kurnik v. Dept. of Health & Rehab. Serv., 661 So. 2d 914 (Fla. 1st DCA 1995). “On appeal, appellant argues that the hearing officer ignored 42 C.F.R. § 431.246 which she maintains requires that the relief she seeks be granted.”
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