Md. Code Regs. 13A.14.06.15

Current through Register Vol. 51, No. 22, November 1, 2024

Section 13A.14.06.15 - Hearings and Appeals

A. Appeal by Customer. A customer may request a hearing if the contractor :

(1) Denies, suspends, reduces, or terminates assistance;

(2) Fails to act with reasonable promptness on an application for, or a request for adjustment of assistance; or

(3) Imposes sanctions on a recipient; or

(4) Recovers an overpayment in assistance.

B. Notice.

(1) The contractor shall send written notice of any adverse action in writing:

(a) To the customer ; and

(b) To a provider who is denied payment for committing an intentional program violation pursuant to Regulation .14M of this chapter.

(2) Notice of any adverse action shall include the:

(a) Decision;

(b) Basis for the decision;

(c) Specific regulation supporting the decision;

(d) Right to request an appeal;

(e) Method by which an appeal may be requested;

(f) Right to be represented in an appeal by a lawyer, relative, friend, or other individual; and

(g) Availability of any free legal services.

(3) The customer or provider may appeal within 90 calendar days of the date of the notice of adverse action .

(4) An appeal request:

(a) Is made by filing a completed MSDE appeal request form with the contractor;

(b) May be received by any employee of the contractor whose assignment requires contact with the public; and

(c) Shall be submitted immediately by the contractor to the designated hearing coordinator.

(5) The filing date of the appeal request is the date the contractor received the completed MSDE appeal request form .

(6) Contractor Assistance in the Appeal Request. The contractor shall assist the appellant in completing an appropriate appeal request form to ensure that it contains all the information required to process the request and, if necessary, shall provide an interpreter.

C. Processing of Appeal Requests.

(1) Within 5 business days of the filing date of an appeal request, the contractor shall:

(a) Forward the following information to OAH:

(i) Date of the request;

(ii) Name and address of the appellant;

(iii) Name and address of the local department representative;

(iv) Action being appealed;

(v) Date of the action being appealed; and

(vi) Date notice of the action was mailed to the appellant; and

(b) Acknowledge to the appellant receipt of the appeal request.

(2) Conference.

(a) When the contractor receives an appeal request, the contractor shall promptly offer the appellant a conference.

(b) A contractor supervisor shall attend the conference.

(c) The case manager responsible for the action may also attend.

(d) Although a conference may lead to an informal resolution of the dispute, a hearing shall be held unless the appellant withdraws the appeal request in writing.

D. Continuation of Assistance Pending Appeal.

(1) Assistance shall be automatically continued or reinstated if the filing date of the appeal request is within 10 calendar days of the intended action.

(2) Assistance may not be continued or reinstated pending appeal if:

(a) An appellant specifically requests that assistance not be continued or reinstated pending appeal;

(b) The eligibility or certification period for the assistance has expired;

(c) Assistance has been reduced or terminated due to a change in federal or State law or regulation and the appeal does not appear to concern misapplication of the change;

(d) Continuation or reinstatement of the service at issue would threaten the health or safety of other individuals; or

(e) The service is terminated because of nonpayment by the family of the copayment stated on the voucher that was assigned by the contractor.

(3) An appeal request form shall contain:

(a) An opportunity for the appellant to request that assistance not be continued or reinstated pending appeal; and

(b) A statement that the appellant is responsible for repaying any assistance paid during the appeal process if the contractor's position is upheld.

E. Denial or Dismissal of Request for Appeal. OAH may deny or dismiss an appeal if:

(1) The appeal request is not complete;

(2) The appellant withdraws the request in writing;

(3) The appellant fails to appear at the scheduled hearing;

(4) Assistance has been reduced or terminated due to a change in federal or State law or regulation and the appeal does not concern misapplication of the change; or

(5) The appellant has failed to pay any filing fees required by OAH.

F. Scheduling and Notice.

(1) Except as provided in §§B and D of this regulation, upon receiving an appeal request, OAH shall:

(2) Intentional Program Violation Hearing. When the contractor makes a referral to OAH concerning an intentional program violation, OAH shall:

(a) Promptly schedule a hearing; and

(b) Send the parties a hearing notice at least 30 calendar days before the scheduled hearing.

(3) Hearing Notice. The hearing notice shall:

(a) Summarize the hearing procedures;

(b) Advise the appellant of:

(i) The date, time, and place of the hearing;

(ii) The right to be represented at the hearing by a lawyer, relative, friend, or other individual;

(iii) The availability of any free legal services;

(iv) The right to present documents and witnesses, including contractor employee s, at the hearing;

(v) The right to examine the case record in preparation for the hearing;

(vi) The procedure to follow if the appellant cannot attend the hearing; and

(vii) Except in an appeal concerning an intentional program violation, the authority of an administrative law judge to dismiss the appeal if the appellant fails, without good cause, to attend the hearing; and

(c) In an appeal concerning an intentional program violation, include:

(i) The charge;

(ii) A warning that the decision shall be based solely on information provided at the hearing if the appellant fails to appear at the hearing;

(iii) A statement that, to have a hearing rescheduled, the appellant has 10 calendar days from the date of the hearing to present to the administrative law judge good cause for not appearing and for not asking for a postponement before the hearing;

(iv) A description of the disqualification penalties and a statement of the applicable penalty;

(v) A statement of the appellant's rights during the hearing; and

(vi) A warning that the hearing does not preclude the State or federal government from prosecuting the appellant or pursuing collection of the overpayment.

G. Prehearing Procedures.

(1) Rescheduling.

(a) A party may request a change in a hearing time, date, or location by:

(i) Submitting a written request, with copies served on all parties, to the OAH clerk's office at least 5 business days before a scheduled hearing; or

(ii) In the case of an unforeseen event requiring postponement and occurring less than 5 business days before a scheduled hearing, calling the OAH clerk's office as soon as possible.

(b) If OAH finds that good cause exists, OAH shall set another time or place for the hearing and notify the parties of the change.

(c) In an appeal concerning an intentional program violation, the appellant is entitled to one postponement of the scheduled hearing of up to 30 calendar days without the need to demonstrate good cause.

(d) Any time limits applicable to the issuance of a final administrative decision are extended by the length of the delay caused by a postponement:

(i) Requested by the appellant; or

(ii) Granted by the administrative law judge due to the appellant's introduction of new evidence.

(2) Summaries. The contractor shall:

(a) Prepare a summary of the facts pertinent to the case and of the basis for its action; and

(b) Send the summary and copies of all documents that it intends to present at the hearing to the appellant and to OAH at least 6 calendar days before the date of the hearing.

H. Administrative Law Judge's Decision.

(1) The administrative law judge shall render a final decision.

(2) The decision shall contain:

(a) Separate statements of findings of fact and conclusions of law;

(b) Citation to pertinent State and federal law; and

(c) An order.

I. Final Decision.

(1) Within 90 calendar days of the filing of the appeal request:

(a) The administrative law judge shall issue a final decision to all parties; and

(b) The contractor shall complete all administrative or corrective action necessary to implement the decision.

(2) If the decision is favorable to the contractor, the contractor may:

(a) Take immediate steps to implement the decision; and

(b) Reduce or terminate assistance that has been continued while the appeal was pending by:

(i) Decreasing the subsidy amount or closing the customer's case; and

(ii) Notifying the child care provider of the reduction or termination pursuant to Regulation .10A.

(3) If the decision is favorable to the appellant, the contractor shall, within 10 calendar days of the date of the decision:

(a) Comply with the decision;

(b) Take corrective action retroactive to the date the incorrect action was taken;

(c) Restore the services; and

(d) Notify OAH that it has completed all required action.

(4) The Record. After issuing a final administrative decision, OAH shall promptly forward to the CCS Branch the complete record, including all:

(a) Papers filed;

(b) Evidence submitted; and

(c) Orders and decisions issued.

Md. Code Regs. 13A.14.06.15

Regulations .15 adopted effective July 21, 1976 (3:15 Md. R. 785)
Regulation .15 adopted and recodified from Regulation .11 effective 42:6 Md. R. 512, eff.3/30/2015