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10.02.03.00.htm 10.02.03.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 02 DIVISION OF REIMBURSEMENTS Chapter 03 Appeal Hearings to the Division of Reimbursements Authority: Health-General Article, §2-207, Annotated Code of Maryland
10.02.03.01.htm 10.02.03.01. 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.2) "Appellant" means any individual who requests an appeal hearing for the
10.02.03.02.htm 10.02.03.02. 02 Opportunity for an Appeal Hearing.. An opportunity for an appeal hearing shall be granted when:. A. A rate is established (or increased) against an individual in an amount which is deemed by the individual to be arbitrary and excessive in accordance with the individual's financial circumstances;B. An individual is aggrieved by any division policy, action, or inaction:. 1) Which affects the charges established or manner of billing; or.
10.02.03.03.htm 10.02.03.03. 03 Notification of Right to Request an Appeal Hearing.. A. Whenever the Division conducts an investigation of an individual's financial resources and issues a notice of rate establishment for services rendered to a recipient of services in accordance with COMAR 10.02.01.05, the Division shall provide written notification to the individual of his or her right to seek an informal review or an appeal, or both, from the rates established by the Division.
10.02.03.03-1.htm 10.02.03.03-1. 03-1 Request for a Rate Review.. A. If a recipient of services or other chargeable person submits a written request that the Division review the notice of rate establishment, the financial agent for the Division shall:1) Review the notice of rate establishment to determine the accuracy of the charges established;. 2) Review all pertinent information presented by the individual to determine if any adjustments in the billing are appropriate under these regulations;
10.02.03.04.htm 10.02.03.04. 04 Request for an Appeal Hearing.. A. Any individual, either himself or through a representative, may request an appeal hearing by giving a clear statement, in writing, to any financial agent of the Division that he desires an opportunity to present for review any matter which is the proper subject of an appeal hearing as provided in Regulation .02. This statement shall be forwarded immediately to the Chief of Reimbursements. When the Division receives a request for a hearing, it
10.02.03.05.htm 10.02.03.05. 05 Pre-Hearing Procedures.. The appellant and the Division may request the names of all witnesses that the other party intends to call at the hearing.
10.02.03.06.htm 10.02.03.06. 06 Hearing Procedures.. A. The appellant and the Division shall have the opportunity to present witnesses, documentary evidence, and oral and written argument, and to cross-examine all adverse witnesses.B. If the appellant wishes to call as witnesses any of the Division's current employees, or former employees who reside within the State, whose action or inaction is being contested by the appellant or whose testimony is, in the judgment of the appellant, relevant to the iss
10.02.03.07.htm 10.02.03.07. 07 The Record.. A. A recording of the hearing shall be made. A copy of the recording shall be supplied to the appellant whenever the appellant takes a further appeal. The recording, together with all exhibits and papers admitted into evidence, shall constitute the exclusive record for decision. 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.B. The recording and copi
10.02.03.08.htm 10.02.03.08. 08 Findings, Conclusions and Decisions.. A. The administrative law judge shall prepare a written summary of findings and conclusions, based exclusively on the record, and shall make a recommendation based on those findings and conclusions. The summary of findings and conclusions shall state the policies, regulations, or laws upon which the decision is based.B. A copy of the findings, conclusions and decisions shall be forwarded to the appellant or his representatives no later than
10.02.03.9999.htm 10.02.03.9999. Administrative History Effective date: July 1, 1971. Regulation .01 amended effective June 28, 1999 (26:13 Md. R. 1019). Regulations .01, .02C, and .03A amended effective May 5, 1986 (13:9 Md. R. 1028). Regulation .01B amended effective March 14, 2016 (43:5 Md. R. 385). Regulation .03-1 adopted effective May 5, 1986 (13:9 Md. R. 1028). Regulation .04B, C amended effective June 28, 1999 (26:13 Md. R. 1019).
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