Md. Code Regs. 10.01.04.04

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.01.04.04 - Request for Fair Hearing

A. Statement of Request.

(1) Any individual, either himself or through an authorized representative, may request a fair hearing by giving a clearstatement, oral or written, to any member of the Department or delegate agency, 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 .02 of this chapter. The request shall be given to:

(a) The Program's Office of Health Services, if the appeal concerns a recipient's services being denied, suspended, terminated, or reduced; or

(b) The Office of Administrative Hearings or the delegate agency, if the appeal concerns the appellant's eligibility.

(2) The Program's Office of Health Services or the delegate agency that receives the request for a hearing shall assist the appellant or the appellant's authorized representative in preparing the request.

(3) The Program's Office of Health Services, or the delegate agency that receives a written statement requesting an appeal shall:

(a) Immediately forward an applicant's statement to the Office of Administrative Hearings; and

(b) Note in its correspondence with the Office of Administrative Hearings if the appeal:

(i) Concerns the medical necessity of a denied benefit or service to an MCO enrollee;

(ii) Meets the Program's criteria for an expedited resolution because the Program has determined that taking the time for a standard resolution could seriously jeopardize the individual's life or health or ability to attain, maintain, or regain maximum function; and

(iii) Must be heard and decided upon within 3 working days after the Office of Administrative Hearings receives the fair hearing request.

B. Acknowledgement. The Office of Administrative Hearings shall:

(1) Promptly acknowledge any request for a fair hearing;

(2) Give advance notice in writing of the date, time, and place of the fair hearing; and

(3) Provide the appellant with the information specified in Regulation .03B of this chapter.

C. Postponements.

(1) If any party notifies the Office of Administrative Hearings that either the time or place designated by the Office of Administrative Hearings is not convenient to the party, and requests a different time or place for the fair hearing, the administrative law judge shall designate another time or place convenient to the parties if the administrative law judge deems that the party has sufficient reason for requesting the change.

(2) If the appellant is employed during the periods when fair hearings are normally held, the administrative law judge shall attempt to schedule the hearing so that the appellant will not be required to miss employment.

D. Timeliness of Appeal. A request for a fair hearing may not be granted unless the request in §A of this regulation is:

(1) Postmarked, delivered in person, or sent by email or facsimile to the Office of Health Services within 120 days of the receipt of the notification specified in Regulation .03A of this chapter, if the appeal concerns services provided or denied by an MCO;

(2) Postmarked, delivered in person, or sent by email or facsimile to the Office of Health Services within 90 days of the receipt of the notification specified in Regulation .03A of this chapter, if the appeal concerns services provided or denied by the fee-for-service program; or

(3) Postmarked, delivered in person, or sent by facsimile to the Office of Administrative Hearings; or emailed to Maryland Health Benefit Exchange; telephoned or faxed to the Consolidated Services Center or postmarked, telephoned, faxed, or delivered in person to the delegate agency within 90 days of the receipt of the notification specified in Regulation .03A of this chapter if the appeal concerns the appellant's eligibility.

E. Dismissal.

(1) The Program, the delegate agency, or the Office of Administrative Hearings may dismiss a request for a fair hearing when the appeal has been:

(a) Withdrawn in writing by the appellant or his authorized representative; or

(b) Abandoned.

(2) An appellant shall be deemed to have abandoned the appellant's request for a fair hearing if the appellant fails to appear for the fair hearing on the established date without good cause as determined by the administrative law judge.

F. Program's Response. In responding to timely filed requests for a fair hearing, the Office of Administrative Hearings:

(1) May respond to a series of individual requests for hearing by conducting a single group hearing;

(2) May consolidate hearings only in cases in which the sole issue involved is one of federal or State law or policy;

(3) Shall follow the regulations of this chapter governing hearings in all group hearings; and

(4) Shall permit each applicant to present the appellant's own case or be represented by the appellant's authorized representative.

Md. Code Regs. 10.01.04.04

Regulations .04A and C amended effective January 14, 1985 (12:1 Md. R. 16)
Regulations .04D amended effective December 14, 1979 (6:25 Md. R. 1980); amended effective 45:4 Md. R. 205, eff. 2/26/2018