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 10.01.04.04 - Request for Fair Hearing
Universal Citation: MD Code Reg 10.01.04.04
Current through Register Vol. 51, No. 19, September 20, 2024
A. Statement of Request.
(1) Any individual,
either himself or through an authorized representative, may request a fair
hearing by giving a clearstatement, oral or written, to any member of the
Department or delegate agency, that the individual desires an opportunity to
present for review any matter which is the proper subject of a fair hearing as
provided in Regulation .02 of this chapter. The request shall be given to:
(a) The Program's Office of Health Services,
if the appeal concerns a recipient's services being denied, suspended,
terminated, or reduced; or
(b) The
Office of Administrative Hearings or the delegate agency, if the appeal
concerns the appellant's eligibility.
(2) The Program's Office of Health Services
or the delegate agency that receives the request for a hearing shall assist the
appellant or the appellant's authorized representative in preparing the
request.
(3) The Program's Office
of Health Services, or the delegate agency that receives a written statement
requesting an appeal shall:
(a) Immediately
forward an applicant's statement to the Office of Administrative Hearings;
and
(b) Note in its correspondence
with the Office of Administrative Hearings if the appeal:
(i) Concerns the medical necessity of a
denied benefit or service to an MCO enrollee;
(ii) Meets the Program's criteria for an
expedited resolution because the Program has determined that taking the time
for a standard resolution could seriously jeopardize the individual's life or
health or ability to attain, maintain, or regain maximum function;
and
(iii) Must be heard and decided
upon within 3 working days after the Office of Administrative Hearings receives
the fair hearing request.
B. Acknowledgement. The Office of Administrative Hearings shall:
(1) Promptly
acknowledge any request for a fair hearing;
(2) Give advance notice in writing of the
date, time, and place of the fair hearing; and
(3) Provide the appellant with the
information specified in Regulation .03B of this chapter.
C. Postponements.
(1) If any party notifies the Office of
Administrative Hearings that either the time or place designated by the Office
of Administrative Hearings is not convenient to the party, and requests a
different time or place for the fair hearing, the administrative law judge
shall designate another time or place convenient to the parties if the
administrative law judge deems that the party has sufficient reason for
requesting the change.
(2) If the
appellant is employed during the periods when fair hearings are normally held,
the administrative law judge shall attempt to schedule the hearing so that the
appellant will not be required to miss employment.
D. Timeliness of Appeal. A request for a fair hearing may not be granted unless the request in §A of this regulation is:
(1) Postmarked, delivered in person, or sent
by email or facsimile to the Office of Health Services within 120 days of the
receipt of the notification specified in Regulation .03A of this chapter, if
the appeal concerns services provided or denied by an MCO;
(2)
Postmarked, delivered in person, or sent by email or facsimile to the Office of
Health Services within 90 days of the receipt of the notification specified in
Regulation .03A of this chapter, if the appeal concerns services provided or
denied by the fee-for-service program; or
(3) Postmarked,
delivered in person, or sent by facsimile to the Office of Administrative
Hearings; or emailed to Maryland Health Benefit Exchange; telephoned or faxed
to the Consolidated Services Center or postmarked, telephoned, faxed, or
delivered in person to the delegate agency within 90 days of the receipt of the
notification specified in Regulation .03A of this chapter if the appeal
concerns the appellant's eligibility.
E. Dismissal.
(1) The Program, the delegate agency, or the
Office of Administrative Hearings may dismiss a request for a fair hearing when
the appeal has been:
(a) Withdrawn in writing
by the appellant or his authorized representative; or
(b) Abandoned.
(2) An appellant shall be deemed to have
abandoned the appellant's request for a fair hearing if the appellant fails to
appear for the fair hearing on the established date without good cause as
determined by the administrative law judge.
F. Program's Response. In responding to timely filed requests for a fair hearing, the Office of Administrative Hearings:
(1) May respond to a series of
individual requests for hearing by conducting a single group hearing;
(2) May consolidate hearings only in cases in
which the sole issue involved is one of federal or State law or
policy;
(3) Shall follow the
regulations of this chapter governing hearings in all group hearings;
and
(4) Shall permit each applicant
to present the appellant's own case or be represented by the appellant's
authorized representative.
Disclaimer: These regulations may not be the most recent version. Maryland 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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