Ala. Admin. Code r. 560-X-64-.15

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-64-.15 - Fair Hearings Of Integrated Care Networks

(1) An integrated care network (ICN) that has been sanctioned by the Medicaid Agency in accordance with Alabama Medicaid Administrative Code Chapter 560-X-64 may request a fair hearing.

(2) An ICN's request for a fair hearing with the Medicaid Agency relating to the imposition of a sanction must be in writing and must be filed with the Medicaid Agency within thirty (30) calendar days of the date of the sanction notice. The written request shall include a statement of the factual and/or legal basis for the ICN's dispute or claim and a statement of the relief or action sought. The Medicaid Agency will not accept requests for fair hearings that are outside the filing deadline. The ICN may submit the written request for fair hearing to the Medicaid Agency by mail, hand-delivery, facsimile or electronic mail, and the request must be received by the Medicaid Agency on or before the filing deadline.

(3) Upon filing a written request for a fair hearing, the ICN may also request an informal conference with the Medicaid Agency to seek a resolution of the ICN grievance.

(4) If the ICN grievance is not resolved through informal conference with the Medicaid Agency, the ICN grievance shall be reviewed in a fair hearing shall be conducted before an impartial hearing officer in accordance with the requirements for contested case proceedings under the Alabama Administrative Procedure Act, Section 41-22-1 et seq. of the Code of Ala. 1975. The hearing authority for all fair hearings of ICN sanctions shall be the Commissioner of the Medicaid Agency, who shall appoint one or more hearing officers to conduct fair hearings and submit findings and recommendations to the Commissioner for final decision on each ICN grievance. The hearing officer shall not have been involved in any way with the ICN sanction in question.

(5) A fair hearing shall be impartially conducted and held at the Medicaid Agency's central office in Montgomery. Written notice of the date, time, place and nature of the fair hearing shall be sent by certified mail to the ICN's address of record and may also be communicated by email or facsimile transmission by the Director, Hearings of the Medicaid Agency, or the designated hearing officer, at least ten (10) calendar days before the hearing is to be held. The notice shall comply with the requirements of Section 41-22-12(b) of the Code of Ala. 1975.

(6) The ICN may be represented at the fair hearing by legal counsel at its own expense. The ICN may call witnesses and may examine witnesses called by other parties.

(7) The Medicaid Agency shall be responsible for payment of the hearing officer(s) fees and expenses and any court reporter's fees and expenses related to the fair hearing.

(8) All fair hearings shall be conducted in accordance with the provisions of Sections 41-22-12 through 41-22-19 of the Code of Ala. 1975, unless otherwise noted in this rule. Within thirty (30) calendar days of the conclusion of the hearing, the findings and recommendations of the hearing officer shall be submitted to the Commissioner of the Medicaid Agency, who shall make a final decision within thirty (30) calendar days of the recommendation. The Medicaid Agency shall promptly send a copy of the final decision to the ICN's address of record by certified mail.

(9) The ICN may seek judicial review of the final decision of the Medicaid Agency in accordance with the provisions of Sections 41-22-20 and 41-22-21 of the Code of Ala. 1975.

(10) Nothing in this rule is intended to create or establish new causes of action in any court. Nothing in this rule shall be construed as a waiver of any sovereign, qualified, or any other type of immunity.

Ala. Admin. Code r. 560-X-64-.15

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 01, October 31, 2017, eff. 11/28/2017.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 11, August 31, 2018, eff. 9/24/2018.

Author: Stephanie Lindsay, Administrator, Administrative Procedures Office

Statutory Authority:Code of Ala. 1975, §§ 22-6-220 et seq.