Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 450.000 - Administrative and Billing Regulations
Section 450.241 - Hearings: Claim for an Adjudicatory Hearing

Universal Citation: 130 MA Code of Regs 130.450

Current through Register 1531, September 27, 2024

(A) A provider may challenge the findings set forth in the MassHealth agency's final determination, issued pursuant to

(1) regulations, including but not limited to, 130 CMR 450.208(C)(2), 450.209(C)(3), 450.209(D), 450.210(D)(1), 450.211(D)(1), 450.213 (as to provider termination based solely upon a determination of ineligibility by the MassHealth agency), 450.237(D), or 450.240(E); or

(2) other formal written issuances of the MassHealth agency which specify that the provider has a right to challenge the findings set forth in the MassHealth agency's final determination using the process set forth in 130 CMR 450.241 through 450.248.

(B) To challenge the findings set forth in the MassHealth agency's final determination, the provider must file a claim for an adjudicatory hearing (claim) with the Board of Hearings and the MassHealth agency within 30 calendar days of the date on the final determination. Pursuant to 130 CMR 450.243, in addition to filing the request for an adjudicatory hearing timely, the provider must specifically identify each issue and fact in dispute and state the provider's position, the pertinent facts to be adduced at the hearing, and the reasons supporting that position. A claim is filed on the date actually received by both the Board of Hearings and the MassHealth agency. The failure to either file a timely claim, state the basis of the claim, or file with both the Board of Hearings and the MassHealth agency in compliance with 130 CMR 450.243 will result in implementation of the action identified in the final determination.

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