Ga. Comp. R. & Regs. 350-4-.02

Current through Rules and Regulations filed through November 21, 2024

Rule 350-4-.02 - Hearings Conducted by the Department of Human Resources

(1) Hearings shall be conducted by the Department of Human Resources in the following cases:

(a) when a recipient of medical assistance is aggrieved by the action or inaction of the Department as to any medical or remedial care or service which such recipient alleges should be reimbursed under the terms of the Georgia State Plan for Medical Assistance which was in effect on the date on which such care or service was rendered or is sought to be rendered;

(b) when an application for medical assistance is denied or is not acted upon with reasonable promptness;

(c) when a recipient or applicant has been aggrieved by an action or inaction of the Department or its agent with respect to a determination of the level of care status applicable to that person;

(d) when individuals are adversely affected by determinations made during the pre-admission screening or post-admission resident review required by Social Security Act °1919(e)(7), as amended, as implemented by Section 4211 of the Omnibus Budget Reconciliation Act of 1987;

(e) when an institution has received notice that it will be:

1. decertified to participate under the State Plan for Medical Assistance,

2. denied a license to operate a nursing facility, or

3. refused enrollment as a provider in the State Plan or terminated as a provider based on the want of any license, permit, certificate, approval, registration, charter or other form of permission issued by the Department of Human Resources;

(f) when a hearing is obtained pursuant to the provisions of Chapter 350-3 of these Rules; and

(g) when a recipient or applicant has been aggrieved by an action of the Department or its agent with respect to collection of funds paid in behalf of the recipient for medical services.

(2) All hearings pursuant to this section will be conducted under the Rules of the Department of Human Resources.

Ga. Comp. R. & Regs. R. 350-4-.02

Ga. L. 1977, pp. 384, 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Repealed: ER. 350-4-0.4-.02 adopted.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Repealed: Permanent Rule entitled "Hearings Conducted by the Department of Human Resources" adopted. F. Oct. 4, 1989; eff. Nov. 1, 1989, as specified by the Agency.