State Fair Hearings

If you are dissatisfied with the results of your first level appeal, you may file a second level of appeal by requesting a State Fair Hearing with the NH DHHS Administrative Appeals Unit (AAU).

To file a State Fair Hearing appeal (second level appeal):

  • You must request a standard State Fair Hearing in writing within 120 calendar days of the date on the plan’s written decision.
  • If you are dissatisfied with the results of your first level appeal from AmeriHealth Caritas New Hampshire AND any delay of services could seriously jeopardize your life, physical or mental health, or ability to attain, maintain, or regain maximum function, you may file an expedited State Fair Hearing with the NH DHHS Administrative Appeals Unit (AAU). You must request an expedited State Fair Hearing in writing immediately upon receipt of the plan’s written decision. If your appeal is to continue benefits for previously authorized services, you must also request continuation of benefits at the same time you file your expedited State Fair Hearing appeal.
  • In most situations, you cannot request a State Fair Hearing without first going through the plan’s standard or expedited (first level appeal) processes described in our appeals section.
  • In your signed, written State Fair Hearing request:
    • Include your name, address, phone number, and email address (if you have one).
    • Describe the date of the action or notice from the plan you want to appeal, and attach a copy of the notice.
    • If you are requesting a standard State Fair Hearing, explain why you want to appeal the decision.
    • If you are requesting an expedited State Fair Hearing, you must state this and explain how any delay of services could seriously jeopardize your life, physical or mental health, or ability to attain, maintain, or regain maximum function.
    • If the plan’s decision was to deny, reduce, limit, suspend or end your previously authorized benefits, indicate whether you want to have previously authorized benefits continued. You must contact the plan to request continuation of benefits.; and
    • Describe any special requirements you will need for the hearing (e.g., handicap accessibility, interpretation services).
  • Send your written State Fair Hearing request to:
    Administrative Appeals Unit NH Department of Health and Human Services
    105 Pleasant Street, Room 121C
    Concord, NH 03301
    Fax: 603-271-8422
  • If you appeal the plan’s decision to deny, reduce, limit, suspend or end services, you may have a right to request continuation of benefits from AmeriHealth Caritas New Hampshire during your appeal. Your provider cannot request continuation of benefits for you. For more information, read about how to request continuation of benefits during an appeal.

Here is what you can expect after you file your standard State Fair Hearing appeal:

  • After you file your State Fair Hearing appeal, you have the right to request and receive a copy of your case file that the plan used to make its decision. A copy of your case file is free of charge and may be requested in advance of the State Fair Hearing decision.
  • For a standard State Fair Hearing appeal, the AAU must resolve your request as expeditiously as your health condition requires, but no later than 90 days after the date you filed your first level appeal with the plan (excluding the number of days it took you to request the State Fair Hearing).
  • If the AAU accepts your request for an expedited State Fair Hearing appeal, the AAU will issue its written decision as expeditiously as your health condition requires, but no later than 3 business days after the AAU receives the plan’s case file and any additional information for your appeal.
  • If the AAU denies your request for an expedited State Fair Hearing appeal, the AAU will make reasonable efforts to give prompt verbal notice to you, and provide written notice of the denial. If your expedited request is denied, your appeal will be treated as a standard State Fair Hearing appeal.
  • The AAU will let you know where the hearing will take place. Hearings are usually held at the AAU in Concord, or at your local NH DHHS District Office.
  • A hearing officer from the AAU will conduct the hearing.
  • You may bring witnesses, present testimony and evidence in person as well as in writing, and question other witnesses at your State Fair Hearing.
  • If the AAU reverses the plan’s decision to deny, reduce, limit, suspend, or end previously authorized benefits that were not provided while the first level appeal and/or State Fair Hearing were pending, the plan will authorize the services as expeditiously as your health condition requires, but no later than 72 hours from the date the plan receives notice that the AAU reversed the plan’s decision.
  • If you received continued benefits while the appeal was pending:
    • If the decision is in your favor, the plan will pay for those services.
    • If you lose your appeal and received continued benefits you may be responsible for the cost of any continued benefits provided by the plan during the appeal period.

For more information, contact the AAU at 1-800-852-3345, extension 4292, Monday through Friday, 8 a.m. – 4 p.m. ET.

You may also contact the NH DHHS Customer Service Center at 1-ASK-DHHS (1-844-275-3447) (TDD Access Relay: 1-800-735-2964), Monday through Friday, 8 a.m. – 4 p.m. ET.

For assistance with requesting a State Fair Hearing, please contact Member Services at 1-833-704-1177 (TTY 1-855-534-6730). You can call 24 hours a day, seven days a week.  

Members