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-.05 - Hearing Requests

Universal Citation: GA Rules and Regs r 350-4-.05

Current through Rules and Regulations filed through September 23, 2024

(1) A request for a hearing must be in writing and received by the Department:

(a) within ten (10) days after the date on which a notice of denial of a request for enrollment or notice of suspension or termination was transmitted to the provider; or

(b) concerning any other action or inaction by the Department which aggrieves the provider, within ten (10) days after the date of the later of:
1. the Department's action for which the hearing is sought, if no opportunity for Administrative Review was available, or

2. notice of the final decision of the entity to which request for Administrative Review has been addressed.

In determining the timeliness of a request, the Department will compute the number of days in accordance with Rule 350-1-.01(24), if the date of the provider's receipt of notice of the adverse action being appealed is known to the Department; if the date of receipt by the provider is not known, the Department shall add five (5) days from the date of transmission of the notice to allow for delivery. Nothing herein shall bar proof of actual date of receipt by the provider or its agent, subject to the provisions of subsection 19.

(2) The request for a hearing must include all of the following:

(a) a clear expression by the provider or an authorized representative that the provider wishes to present a case to an Administrative Law Judge;

(b) identification of the adverse administrative review decision or other Department action being appealed and, if only part of such decision or action aggrieves the provider, the specific part which the provider will address at the hearing;

(c) a specific statement of why the provider believes the administrative review decision or other Department action is wrong; and

(d) a statement of the relief sought.

(3) If any of the requirements listed in Paragraph (2) have not been met, the Department shall so notify the provider. Thereafter, the Department must receive a corrected request within ten (10) days of the provider's receipt of the deficiency notice or the request shall be deemed untimely.

(4) Requests for hearings shall be denied if the Department determines that:

(a) the request was not timely filed;

(b) the action or inaction appealed by the provider is solely the result of a change in state or federal law;

(c) the issues raised by the provider fall outside the jurisdiction of the administrative hearing process; or

(d) the requesting party has not been aggrieved.

If there is a bona fide question of fact concerning any of the items described in this Subsection 4, and the provider establishes such question of fact by sworn affidavit within a reasonable time set by the Office of Special Services and made known in writing to the provider, the Department shall grant a hearing and defer these questions for final determination by the Administrative Law Judge.

Ga. L. 1977, p. 384, et seq.; O.C.G.A. Sec. 49-4-142(a), 153.

Disclaimer: These regulations may not be the most recent version. Georgia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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