Code of Massachusetts Regulations
956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY
Title 956 CMR 7.00 - Small Group Wellness Incentive Program
Section 7.06 - Appeals

(1) An employer may appeal a decision by the Connector that the employer does not meet the definition of an Eligible Small Employer, that the Eligible Small Employer has not met the participation requirements set forth in 956 CMR 7.05(1), or that the Connector's calculation of the amount of the Eligible Small Employer's Rebate Payment is not correct.

(2) The Connector shall provide written notice to the employer of an adverse decision with respect to eligibility as an Eligible Small Employer, the Eligible Small Employer's satisfaction of participation requirements as set forth in 956 CMR 7.05(1), or the amount of the Eligible Small Employer's Rebate Payment.

(3) The employer must appeal the decision to the Connector within 30 days after the receipt of the notice of the adverse decision. In the absence of evidence to the contrary, the Connector will presume that the notice was received on the third day after mailing. An employer must appeal in writing on a form designated by the Connector.

(4) Appeals brought to the Connector under 956 CMR 7.06 will be heard by a hearing officer designated by the Director. Hearings will be conducted using the policies and procedures set forth for informal hearings pursuant to 801 CMR 1.02: Formal Rules or in any administrative bulletins issued by the Connector pursuant to 956 CMR 7.07. The hearing may be conducted by telephone. The decision may be made based solely on written submissions and documents. The decision of the hearing officer will be the final decision of the Connector.

(5) The Connector's final decision on the appeal will be subject to an action for judicial review under M.G.L. c. 30A, § 14.