Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 1
Subtitle 01 - PROCEDURES
Chapter 10.01.04 - Fair Hearing Appeals Under the Maryland State Medical Assistance Program
Section 10.01.04.02 - Opportunity for a Fair Hearing
Universal Citation: MD Code Reg 10.01.04.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. An opportunity for a fair hearing shall be granted if:
(1) A Program applicant claims their
application for Program eligibility is denied;
(2) A Program applicant claims that the determination of
eligibility received through Maryland Health Connection is incorrect;
(3) A Program applicant claims their
application for eligibility, or any part thereof, is not acted upon within:
(a) 30 days from the date of application to
an insurance affordability program;
(b) 45 days from the date of application for
aged or blind applicants to the Program; or
(c) 60 days from the date of application to
the Program in the case of determination of disability;
(4) A Program recipient asserts their claim
for Program services has been erroneously denied or is not acted upon with
reasonable promptness;
(5) A
Program recipient asserts that the Program has acted erroneously;
(6) A Program recipient residing in a
skilled nursing facility or nursing home asserts that the recipient has been or
will be erroneously transferred or discharged;
(7) A Program recipient asserts that the Program has made an
erroneous decision related to nursing home preadmission and annual review;
or
(8) A Program participant in an
MCO is appealing an action by an MCO and the appeal has been filed within 120
days from the date specified in the notice from the MCO as required by COMAR
10.09.71.05.
B. The administrative law judge may not grant a fair hearing if the sole issue is a federal or State law requiring an automatic change adversely affecting some or all Program recipients.
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