Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.10 - Nursing Facility Services
Section 10.09.10.34 - Appeal Procedures
Universal Citation: MD Code Reg 10.09.10.34
Current through Register Vol. 51, No. 19, September 20, 2024
A. Except as provided for in §B of this regulation, providers filing appeals from administrative decisions made in connection with these regulations shall do so according to [State Government Article, Title 10, Subtitle 2, and Health-General Article, §2-201 "2-207, Annotated Code of Maryland] COMAR 10.09.36.09C.
B. Nursing Home Appeal Board.
(1) Appeals regarding rate calculations or
cost report adjustments which cannot be resolved administratively go to the
Nursing Home Appeal Board.
(2) The
Appeal Board shall be composed of the following members:
(a) A representative of the nursing home
industry who is:
(i) Knowledgeable in
Medicare and Medicaid reimbursement principles; and
(ii) Appointed by the Secretary;
(b) An individual who:
(i) Is employed by the State;
(ii) Knowledgeable in Medicare and Medicaid
reimbursement principles;
(iii) Did
not directly participate in the field verification or desk review;
and
(iv) Is appointed by the
Secretary; and
(c) A
third member selected by the first two members of the Board.
(3) When the Board is reviewing an
appeal from a provider in which a Board member is employed or in which he has a
financial or personal interest, the Secretary shall designate an alternate for
that member.
(4) If the provider
elects to appeal to the Appeal Board and the Appeal Board finds in favor of the
provider, the Department shall initiate a claims adjustment settlement for the
impacted service dates within 60 days after the notification of the
findings.
(5) The Department or any
provider aggrieved by a reimbursement decision of the Appeal Board may not
appeal to the Board of Review but may take a direct judicial appeal. The appeal
shall be made as provided for judicial review of final decisions in the
Administrative Procedure Act,§10-222, State Government Article, Annotated
Code of Maryland.
(6) An appeal
shall be filed in accordance with COMAR 10.01.09.
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