Md. Code Regs. 10.01.04.03

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

Section 10.01.04.03 - Notification of Right to Request a Fair Hearing

A. The Program, delegate agency, or MCO shall notify an individual and his or her authorized representative, if previously designated by the individual or recognized as valid by the Program, in writing:

(1) Of the right to obtain a fair hearing;

(2) Of the method to obtain the hearing; and

(3) That the individual may represent himself or use an authorized representative at a fair hearing.

B. The notification specified in §A of this regulation shall:

(1) Be provided by the Program, the MCO, or the delegate agency when:

(a) The individual applies for Program benefits;

(b) Any Program, MCO, or delegate agency action affects the individual's claim to Program benefits;

(c) A skilled nursing facility or a nursing facility notifies the individual that the individual is to be transferred or discharged; and

(d) The individual receives an adverse determination by the Department or delegate agency with regard to skilled nursing facility or a nursing facility preadmission screening and annual resident review;

(2) Include a statement of the action the Program, MCO, skilled nursing facility, or nursing facility intends to take;

(3) Include the reasons for the intended action;

(4) Include the specific regulations that support, or the change in federal or State law that requires, the action;

(5) Include an explanation of the individual's right to request a fair hearing, including that expenses incurred in connection with a fair hearing, such as transportation and baby-sitting costs, but not including attorney's fees, shall be paid by the Department when incurred by the appellant and may be paid by the Department when incurred by the appellant's witnesses;

(6) Include a summary of the regulations relating to fair hearing procedures;

(7) Include an explanation of the circumstances under which assistance is continued if a fair hearing is requested, as provided in Regulation .04B of this chapter;

(8) Identify who may act as an authorized representative of the appellant in the fair hearing process;

(9) Specify that the appellant or the appellant's authorized representative may generally examine the appellant's records upon reasonable notice to the Program, MCO, or delegate agency; and

(10) Except as specified in §C of this regulation, be mailed at least 10 days before the date of action.

C. The notice specified in §A of this regulation may be mailed less than 10 days before but not later than the date of action if:

(1) The Program has information confirming the recipient's death;

(2) The Program receives a clear written statement signed by a recipient that:

(a) The recipient no longer wishes services; or

(b) Gives information that requires termination or reduction of services and indicates that the recipient understands that this change in services is the result of supplying that information;

(3) The recipient has been admitted to an institution where the recipient is ineligible under the Program for further services;

(4) Subject to Regulation .10B(4) of this chapter, the recipient's whereabouts are unknown and the post office returns to the Program or delegate agency mail directed to the recipient indicating no forwarding address;

(5) The Program establishes that the recipient has been accepted for Program services by another local jurisdiction, State, territory, or commonwealth;

(6) The recipient's physician prescribes a change in the level of care;

(7) The notice involves an adverse determination made with regard to preadmission screening requirements;

(8) The date of action will occur in less than 10 days and the action involves a long-term care facility's resident transfer or discharge, in which case the notification shall be made as soon as practicable before transfer or discharge in accordance with 42 CFR § 438.12; or

(9) The Program has facts indicating that action should be taken because of probable fraud by the recipient and the facts have been verified, if possible, through secondary sources, in which case the notification may be mailed 5 days before the date of action.

Md. Code Regs. 10.01.04.03

Regulations .03C amended effective January 14, 1985 (12:1 Md. R. 16); amended effective 45:4 Md. R. 205, eff. 2/26/2018; amended effective 46:23 Md. R. 1065, eff. 11/18/2019