Skip to Main Content
<< Back | Return to Main COMAR Search Page

16 records match your request.

FileAbstract
14.35.11.00.htm 14.35.11.00. Title 14 INDEPENDENT AGENCIES Subtitle 35 MARYLAND HEALTH BENEFIT EXCHANGE Chapter 11 Fair Hearings of Individual Exchange Eligibility Determinations Authority: Insurance Article, §31-106(c)1)iv) and 31-108(b)1) (10) and (17) Annotated Code of Maryland
14.35.11.01.htm 14.35.11.01. 01 Scope.. This chapter applies to eligibility determinations and redeterminations for enrollment in qualified health plans, advance payments of the premium tax credit, and cost-sharing reductions offered through the Individual Exchange, as well as for MAGI-based eligibility determinations and redeterminations for the Maryland State Medicaid program and the Maryland Children’s Health Insurance Program.
14.35.11.02.htm 14.35.11.02. 02 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.
14.35.11.03.htm 14.35.11.03. 03 Opportunity for a Fair Hearing.. A. An opportunity for a fair hearing shall be granted if an applicant claims that:. 1) The determination or redetermination received from the Exchange of the applicant’s eligibility for enrollment in a qualified health plan is incorrect;2) The determination or redetermination received from the Exchange of the applicant’s eligibility for an insurance affordability program is incorrect; or3) The determination or redetermination received f
14.35.11.04.htm 14.35.11.04. 04 Notification of Right to Request a Fair Hearing.. A. The Exchange shall notify an individual and the individual’s authorized representative, if previously designated by the individual or recognized as valid by the Exchange, in writing:1) Of the right to obtain a fair hearing;. 2) Of the method to obtain the hearing;. 3) That the individual may represent the individual or use an authorized representative at a fair hearing;4) Of the circumstances under which the individual
14.35.11.05.htm 14.35.11.05. 05 Request for Fair Hearing.. A. Statement of Request.. 1) Any individual, either personally or through an authorized representative, may request a fair hearing by giving a clear statement, oral, electronic, or written, 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 .03 of this chapter. The request shalla) Contacting the Exchange in writing, by mail, telephone, email, or fax;.
14.35.11.06.htm 14.35.11.06. 06 Prehearing 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 Exchange may request the names of all witnesses that the other party intends to call at the fair hearing.
14.35.11.07.htm 14.35.11.07. 07 Hearing Procedures.. A. The appellant and the Exchange 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 relevant; and. 5) Question or refute any testimony or evidence, including an opportunity to confront and cross-examine all witnesses the administrative law judge judges to be adverse.
14.35.11.08.htm 14.35.11.08. 08 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
14.35.11.09.htm 14.35.11.09. 09 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
14.35.11.10.htm 14.35.11.10. 10 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
14.35.11.11.htm 14.35.11.11. 11 Program 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 .04 of this chapter and:a) The appellant or the appellant’s authorized representative does not timely request a hearing in accordance with Regulation .05 of this chapter; orb) The appellant or the appellant’s authorized rep
14.35.11.12.htm 14.35.11.12. 12 Eligibility for Enrollment in a Qualified Health Plan, for Advance Payments of Premium Tax Credit, and for Cost-Sharing Reductions Pending Appeal.A. Eligibility for Enrollment in a Qualified Health Plan.. 1) If, upon initial determination, an applicant has been determined to be ineligible to enroll in a qualified health plan, the applicant may not enroll in a qualified health plan pending the outcome of the appeal.2) Except where the applicant does not appeal a re
14.35.11.13.htm 14.35.11.13. 13 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.
14.35.11.14.htm 14.35.11.14. 14 Authorized Representatives.. A. Definitions.. 1) “Authorized representative” means an individual or organization acting responsibly on behalf of the applicant in accordance with this regulation, in assisting with an applicant’s application, renewal of eligibility, appeals, and other ongoing communications with the Exchange.2) “Signature” includes electronic, including telephonically recorded, signatures and handwritten signatures transmitted by facsimile or other electro
14.35.11.9999.htm 14.35.11.9999. Administrative History Effective date: June 8, 2015 (42:11 Md. R. 726).
<< Back | Return to Main COMAR Search Page