California Code of Regulations
Title 10 - Investment
Chapter 5.5 - Major Risk Medical Insurance Board
Article 5 - Appeals
Section 2698.504 - Hearings

Universal Citation: 10 CA Code of Regs 2698.504

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

Upon receipt of an appeal which requests an administrative hearing, the Board shall determine the appropriate forum as follows:

(a) An appeal filed pursuant to subsection (a) of section 2698.500 shall be reviewed by the Board to determine whether it is practicable to have the hearing conducted by an Administrative Law Judge employed by the Office of Administrative Hearings pursuant to the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. The Board will determine practicability by considering such issues as timing, location and costs to the parties. If it is determined to be practicable, such a hearing shall be scheduled. If it is determined not to be practicable, the appeal shall be heard in accordance with subsection (b) of this Section.

(b) An appeal filed pursuant to subsection (a) of section 2698.500 but which it has been determined by the Board should be heard in accordance with this subsection, shall be heard according to the appeal procedures, including pre- and post-hearing procedures, set forth in Chapter 2.5 (commencing with section 251) of Division 2 of Title 1 of the California Code of Regulations. Chapter 2.5, as adopted on June 4, 1984, is hereby incorporated by reference, subject to the following modifications:

(1) Reference to the Health and Welfare Agency or the component department shall be deemed reference to the Managed Risk Medical Insurance Board.

(2) Reference to the private non-profit human service organization shall be deemed reference to the petitioner.

(3) Reference to the grievance procedure established in accordance with Health and Safety Code section 38036 shall be deemed reference to the administrative review process set forth in section 2698.503.

(4) Reference to Health and Safety Code sections providing the bases, grounds, authorization or procedures for appeals shall be deemed reference to the bases and authorization for appeal found in section 2698.500, and the appeal procedures found in this section.

(5) The 30-day time period specified in section 251(b) shall be extended to 60 days, and the 10-day time period in section 252(a) shall be extended to 30 days.

(6) If the proposed decision submitted to the Board is not adopted as the decision, the Board may itself decide the case on the record, or may refer the case to the same hearing officer to take additional evidence. If the case is referred back to the hearing officer, the hearing officer shall prepare a new proposed decision based on the additional evidence and the record of the prior hearing.

(7) The decision of the Board shall be issued within 90 days following the initial hearing or, if the case is referred back to the hearing officer, within 90 days of the second hearing.

1. New section filed 12-20-90 as an emergency; operative 18-20-90 (Register 91, No. 11). A Certificate of Compliance must be transmitted to OAL by 4-19-91 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-20-90 order transmitted to OAL on 4-18-91 and filed 5-17-91 (Register 91, No. 27).
3. Editorial correction of printing error in subsection (b) (Register 91, No. 27).
4. Amendment of subsection (b), new subsections (b)(1)-(7) and amendment of NOTE filed 1-10-95 as an emergency; operative 1-10-95 (Register 95, No. 2). A Certificate of Compliance must be transmitted to OAL 5-10-95 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 1-10-95 order including amendment of subsections (a)-(b) transmitted to OAL 4-25-95 and filed 6-7-95 (Register 95, No. 23).
6. Amendment of subsections (a) and (b) filed 8-4-2003 as an emergency; operative 8-4-2003 (Register 2003, No. 32). Amendments to remain in effect for 180 days pursuant to section 21, chapter 794, Statutes of 2002 (AB 1401). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and filed 3-1-2004 (Register 2004, No. 10).

Note: Authority cited: Sections 12711 and 12712, Insurance Code. Reference: Sections 12711 and 12732, Insurance Code.

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