Code of Maine Rules
14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
191 - MENTAL HEALTH AND MENTAL RETARDATION - GENERAL
Chapter 40 - REQUIREMENTS FOR FUNDING SERVICES
Section 191-40-IV - APPEALS

A. Informal review

Providers and persons who have been denied payment for services may request a review by the Program Director overseeing the service. The request must be made in writing to the Program Director and must arrive within ten (10) working days of the denial of payment. The request for review shall state the reasons for the request and shall be accompanied by any supporting documentation. Supporting documentation must include that described at III.A. above

After receiving the request for review, the Program Director shall promptly review the request, the material submitted in support of the request and any other material available to the Program Director and relevant to the decision. Within thirty (30) working days of the receipt of the request, the Program Director shall respond to the provider and person in writing, stating the determination of the review and the reason(s) for the determination.

B. Administrative Hearing; Recommended Decision

The provider or person who receives an adverse determination of an informal review may request an administrative hearing by submitting a written request therefore to the Commissioner no later than thirty (30) calendar days following the date of the Program Director's decision. The issues in the administrative hearing and in any appealstherefrom shall be limited to the issues raised by the provider or person in writing in the informal review. A provider or person who fails to submit a request for informal review shall be deemed to have waived the right to an administrative hearing and to any further review of the decision.

The Commissioner shall forward the request for administrative hearing to an independent hearing officer or independent hearings unit within seven (7) calendar days of receipt. At least twenty (20) calendar days before the administrative hearing, the hearing officer or hearings unit shall notify the provider or person of the date, time and place of the hearing and the name of the hearing officer. The hearing shall be held in conformity with the Maine Administrative Procedure Act, 5 MRSA9051et seq. The provider or person may be represented by legal counsel at the hearing and may request the issuance of subpoenas to compel other persons to appear at the hearing to testify on relevant issues. An electronic recording or verbatim transcript must be made of any administrative hearing pursuant to this section.

Unless otherwise agreed by the parties, the hearing officer must issue, and file with the Commissioner, a written recommended decision with findings of fact within ten (10) calendar days of the close of the hearing.

C. Final Decision of Commissioner

Any recommended decision of a hearing officer is subject to further review by the Commissioner, who must issue a final decision adopting, modifying, or rejecting the hearing officer's recommended decision. The Commissioner must issue the final decision no later than thirty (30) calendar days from the date of receipt of the recommended decision. Parties may submit written memoranda to the Commissioner within ten (10) calendar days of the date of the recommended decision. The recommended decision of a hearing officer shall be deemed adopted by the Commissioner if no final decision is issued within thirty (30) calendar days from the date of receipt of the recommended decision.

The Commissioner's decision constitutes final agency action for purposes of judicial review under the Maine Administrative Procedure Act.