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10.01.04.00.htm 10.01.04.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 01 PROCEDURES Chapter 04 Fair Hearing Appeals Under the Maryland State Medical Assistance Program Authority: Health-General Article, §2-104, Annotated Code of Maryland
10.01.04.01.htm 10.01.04.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Administrative law judge" means an individual appointed by the Chief Administrative Law Judge under State Government Article, §9-1604, Annotated Code of Maryland, or designated by the Chief Administrative Law Judge under State Government Article, §9-1607, Annotated Code of Maryland, to adjudicate contested cases at the Maryland Office of Administrative Hearings.
10.01.04.02.htm 10.01.04.02. 02 Opportunity for a Fair Hearing.. 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 Program eligibility, or any part thereof, is not acted upon within 30 days from the date of application or 60 days from the
10.01.04.03.htm 10.01.04.03. 03 Notification of Right to Request a Fair Hearing.. A. The Program or delegate agency shall notify an individual and his or her authorized representative, if previously designated by the individual or recognized as valid by the Program, in writing:1) Of the right to obtain a fair hearing;. 2) Of the method to obtain the hearing; and. 3) That the individual may represent himself or use an authorized representative at a fair hearing..
10.01.04.04.htm 10.01.04.04. 04 Request for Fair Hearing.. A. Statement of Request.. 1) Any individual, either himself or through an authorized representative, may request a fair hearing by giving a clear statement, oral, electronic, 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 a) Contacting the Program
10.01.04.05.htm 10.01.04.05. 05 Pre-Hearing Procedures.. A. A hearing summary shall be prepared containing pertinent information detailing the specific action that is the basis for the appeal. The summary shall be forwarded to the appellant or the appellant’s authorized representative and to the Office of Administrative Hearings at least 6 days before the hearing date.B. The appellant and the Department may request the names of all witnesses that the other party intends to call at the fair hearing.
10.01.04.06.htm 10.01.04.06. 06 Hearing Procedures.. A. The appellant, the Program, and the delegate agency shall have the opportunity to:. 1) Present witnesses;. 2) Present documentary evidence;. 3) Present oral and written argument without undue interference;. 4) Establish all facts and circumstances the administrative law judge judges to be pertinent; and. 5) Question or refute any testimony or evidence, including an opportunity to confront and cross-examine all witnesses the administrative law judge jud
10.01.04.07.htm 10.01.04.07. 07 The Record.. A. A verbatim recording of the fair hearing shall be made. Nonrecorded or confidential information, which the appellant does not have an opportunity to hear or see, may not be made a part of the hearing record. One transcribed copy of the recording shall be supplied to the appellant at no cost if the appellant takes a further appeal.B. The following shall constitute the exclusive record of the hearing:. 1) The transcript or recording of testimony and ex
10.01.04.08.htm 10.01.04.08. 08 Findings, Timing of Decision, and Effect of Decision.. A. Findings.. 1) The administrative law judge shall:. a) Prepare a written summary of findings and conclusions based exclusively on the record; and. b) Make a decision based on his findings and conclusions.. 2) The summary of findings and conclusions shall:. a) State the evidence, policies, regulations, or laws upon which the administrative law judge's decision is based; andb) Provide written notice to the appellant that, i
10.01.04.09.htm 10.01.04.09. 09 Confidentiality.. A. If the appellant waives in writing his privilege of confidentiality as to the fair hearing, the administrative law judge shall permit members of the public to attend the hearing.B. The administrative law judge may cause the removal of any member of the public whose conduct impedes the orderly progress of the hearing, or recess the hearing until it may proceed in orderly fashion.C. The administrative law judge may exclude from the hearing individuals wh
10.01.04.10.htm 10.01.04.10. 10 Benefits During Appeals Process.. A. Benefits Pending Outcome of the Hearing.. 1) The Program may terminate or reduce services effective as of the date specified in the notice if the Program timely mails the notice as required under Regulation .03 of this chapter and:a) The appellant or the appellant’s authorized representative does not timely request a hearing in accordance with Regulation .04 of this chapter; orb) The appellant or the appellant’s authorized rep
10.01.04.11.htm 10.01.04.11. 11 Applicability of Regulations.. If a conflict exists between this chapter and the Rules of Procedure of the Office of Administrative Hearings in COMAR 28.02.01, this chapter shall govern.
10.01.04.12.htm 10.01.04.12. 12 Authorized Representatives.. A. Definitions.. 1) “Authorized representative” means an individual or organization acting responsibly on behalf of the applicant or recipient in accordance with §B, C, D, and E of this regulation, in assisting with an applicant or recipient’s application, renewal of eligibility, appeals, and other ongoing communications with the agency.2) “Signature” includes electronic, including telephonically recorded, signatures and handwritten si
10.01.04.9999.htm 10.01.04.9999. Administrative History Effective date: April 1, 1971. Regulations .01C, .03C, 04A and C, .05A, .06B and D, .07B, .08, .09, .10 amended effective January 14, 1985 (12:1 Md. R. 16)Regulations .04D and .08B amended effective December 14, 1979 (6:25 Md. R. 1980) ―. Chapter revised effective March 19, 2012 (39:5 Md. R. 382). Regulation .01B amended effective April 15, 2013 (40:7 Md. R. 610). Regulation .01B amended as an emergency provision effective October 1, 2013
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