Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter VI
Section 144-101-VI-01 - Primary Care Case Management (replaced by Section 03 on June 21, 2022)
Subsection 144-101-VI-01.10 - INFORMAL CONFERENCES/ADMINISTRATIVE HEARINGS

A. General Members who have a grievance may request either an informal conference and/or an administrative hearing. A member does not have to file a complaint before filing a grievance.

B. Informal Conferences Members may request an informal conference with the OMS. Requests may be made verbally or in writing by contacting MaineCare Member Services. The request must be made within ten (10) calendar days of the date of the notice of adverse findings.

The OMS will schedule an informal conference within ten (10) calendar days of receipt of the request and will give written notice prior to the informal conference to the following parties:

The member requesting the conference; The staff responsible for the decision affecting the member, if appropriate; and The member's designated representative, if known.

The Director of OMS or a designee who was not involved in the decision under review will conduct the conference and allow all participants to offer relevant information. A record of the conference will be made, including the identity of the participants, a summary of the information presented, and copies of all written material presented or submitted.

The Director of OMS or his/her designee will issue a written decision of the matter within ten (10) calendar days of the date of the conference. The decision will include a brief statement of the reasons for the decision and an explanation of the member's right to request an administrative hearing if s/he is dissatisfied with the decision. The OMS will mail a copy of the decision to each party entitled to receive notice.

C. Administrative Hearings All members may request an administrative hearing in accordance with provisions of Chapter I of this Manual.