45 CFR §152.26

1. (a)General. A PCIP shall establish and maintain procedures for individuals to appeal eligibility and coverage determinations.
2. (b)Minimum requirements. The appeals procedure must, at a minimum, provide:
   1. (1)A potential enrollee with the right to a timely redetermination by the PCIP or its designee of a determination regarding PCIP eligibility, including a determination of whether the individual is a citizen or national of the United States, or is lawfully present in the United States.
   2. (2)An enrollee with the right to a timely redetermination by the PCIP or its designee of a determination regarding the coverage of a service or the amount paid by the PCIP for a service.
   3. (3)An enrollee with the right to a timely reconsideration of a redetermination made under paragraph (b)(2) of this section by an entity independent of the PCIP.