Md. Code Regs. 14.35.11.04

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.11.04 - Notification of Right to Request a Fair Hearing

A. The Exchange shall notify an individual and the individual's authorized representative, if previously designated by the individual or recognized as valid by the Exchange, in writing:

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

(2) Of the method to obtain the hearing;

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

(4) Of the circumstances under which the individual's eligibility may be maintained or reinstated pending an appeal decision; and

(5) That an appeal decision for one household member may result in a change in eligibility for other household members, and that such a change will be handled as a redetermination of eligibility for other household members.

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

(1) Be provided by the Exchange when:

(a) The individual applies for enrollment in a qualified health plan and, if applicable, for an insurance affordability program; or

(b) Any Exchange action affects the individual's claim to enrollment in a qualified health plan, or to eligibility for, or the amount of, an insurance affordability program.

(2) Include a statement of the action the Exchange 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) To the extent required by law for Program benefits, 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 information about fair hearings;

(7) Include an explanation of the circumstances under which Program benefits are continued if a fair hearing is requested as provided in Regulation .05 of this chapter;

(8) Identify who may act as an authorized representative of the appellant in the fair hearing process, explain how an applicant may designate an authorized representative, and provide information about designation procedures under Regulation .14 of this chapter;

(9) Specify that the appellant or the appellant's authorized representative may examine the appellant's records upon reasonable notice to the Exchange; and

(10) For termination of Program benefits, be mailed at least 10 days before the date of action except as specified under COMAR 10.01.04.03C.

C. The notice specified in §A of this regulation shall be mailed in accordance with 45 CFR § 155.310(g) if the action is a determination or redetermination regarding eligibility for enrollment in a qualified health plan or eligibility for an insurance affordability program described in Regulation .02B(10)(d) or (e) of this chapter.

Md. Code Regs. 14.35.11.04

Regulation .04 adopted effective 42:11 Md. R. 726, eff.6/8/2015