Compilation of Rules and Regulations of the State of Georgia
Department 350 - DEPARTMENT OF MEDICAL ASSISTANCE
Chapter 350-4 - ADMINISTRATIVE REVIEW, HEARINGS AND APPEALS
Rule 350-4-.01 - Hearings Conducted by the Department of Medical Assistance
Universal Citation: GA Rules and Regs r 350-4-.01
Current through Rules and Regulations filed through March 20, 2024
(1) An Administrative Law Judge appointed by the Department shall conduct provider hearings with respect to the following cases:
(a) when a provider is aggrieved by an action of the Department
with respect to a denial of, or the determination of the amount of, medical
assistance paid on a certain item of medical or remedial care or service
rendered by such provider;
(b) when a provider of medical assistance is aggrieved by an
action of the Department with respect to the Department's determination of the
provider's billing rate or reimbursement rate for a particular fiscal
year;
(c) when a person or institution either has been refused
enrollment as a provider in the State Plan or has been suspended or terminated
as a provider by the Department for any reason other than want of any license,
permit, certificate, approval, registration, charter, or other form of
permission issued by an entity other than the Department, which form of
permission is required by law either to render care or to receive medical
assistance in which federal financial participation is available;
(d) when a provider is aggrieved by any adverse action
specified in these Rules, except as provided in Chapter 350-3, or a Policies
and Procedures Manual published by the Department.
(2) All such hearings shall be conducted in accordance with the rules contained in this Chapter.
Ga. L. 1977, pp. 384, 391, 392, 393; O.C.G.A. Sec. 49-4-142(a), 153.
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