Rule 350-4-.01 - Hearings Conducted by the Department of Medical Assistance(1) An Administrative Law Judge appointed by the Department shall conduct provider hearings with respect to the following cases:(a) when a provider is aggrieved by an action of the Department with respect to a denial of, or the determination of the amount of, medical assistance paid on a certain item of medical or remedial care or service rendered by such provider;(b) when a provider of medical assistance is aggrieved by an action of the Department with respect to the Department's determination of the provider's billing rate or reimbursement rate for a particular fiscal year;(c) when a person or institution either has been refused enrollment as a provider in the State Plan or has been suspended or terminated as a provider by the Department for any reason other than want of any license, permit, certificate, approval, registration, charter, or other form of permission issued by an entity other than the Department, which form of permission is required by law either to render care or to receive medical assistance in which federal financial participation is available;(d) when a provider is aggrieved by any adverse action specified in these Rules, except as provided in Chapter 350-3, or a Policies and Procedures Manual published by the Department.(2) All such hearings shall be conducted in accordance with the rules contained in this Chapter.Ga. Comp. R. & Regs. R. 350-4-.01
Ga. L. 1977, pp. 384, 391, 392, 393; O.C.G.A. Sec. 49-4-142(a), 153.
Original Rule was filed on April 11, 1978; effective May 1, 1978.Repealed: ER. 350-4-0.4-.01 adopted. F. Oct. 5, 1989; eff. Sept. 29, 1989, the date of adoption, to remain in effect for 120 days or until adoption of a permanent Rule superseding said Emergency Rule, as specified by the Agency.Repealed: Permanent Rule entitled "Hearings Conducted by the Department of Medical Assistance" adopted. F. Oct. 4, 1989; eff. Nov. 1, 1989, as specified by the Agency.