Md. Code Regs. 14.35.11.05

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

Section 14.35.11.05 - Request for Fair Hearing

A. Statement of Request.

(1) Any individual, either personally or through an authorized representative, may request a fair hearing by giving a clear statement, oral, electronic, or written, 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 .03 of this chapter. The request shall be made by:

(a) Contacting the Exchange in writing, by mail, telephone, email, or fax;

(b) Contacting the Consolidated Services Center maintained by the Exchange by mail, telephone, or fax;

(c) Contacting the delegate agency in person or by mail, telephone, or fax;

(d) Contacting the Department's Office of Health Services in person or by mail, telephone, or fax; or

(e) Contacting the Office of Administrative Hearings in person, or by mail or fax.

(2) The Program's Office of Health Services, the Exchange, the Consolidated Services Center, or the delegate agency that is contacted by an appellant or the appellant's authorized representative about requesting a hearing shall assist the appellant or the appellant's authorized representative in preparing the request.

(3) The Program's Office of Health Services, the Exchange, the Consolidated Services Center, or the delegate agency that receives or prepares a written statement on behalf of the appellant or the appellant's authorized representative requesting an appeal shall:

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

(b) Indicate whether the appeal is for a determination or redetermination of eligibility to enroll in a qualified health plan or eligibility for an insurance affordability program, if known; and

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

(i) Concerns an immediate need for health services where the appellant's life, health, or ability to attain, maintain, or regain maximum function would be jeopardized by the standard appeal process; and

(ii) To the extent required by applicable law, must be heard and decided within 3 working days after the Office of Administrative Hearings receives the fair hearing request.

(4) If a request for a hearing is made by someone other than the applicant, the Office of Administrative Hearings shall:

(a) Treat the appeal as timely noted if it complies with §D of this regulation, provided documentation pursuant to §A(4)(b) is provided on or before the hearing date, except that no documentation shall be required for representation pursuant to §A(4)(c) of this regulation;

(b) Accept appropriate documentation, up to and including the date of the fair hearing, demonstrating that the representative is authorized; and

(c) Accept the representation of any member of the bar of Maryland that the individual appellant is the member's client without further documentation.

B. Acknowledgement. The Office of Administrative Hearings shall:

(1) Send timely acknowledgement to the appellant, and the appellant's authorized representative, if applicable, of the receipt of the fair hearing request;

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

(3) Provide the appellant with the information specified in Regulation .04A(4) of this chapter; and

(4) Provide an explanation that any advance payments of the premium tax credit paid on behalf of the appellant pending appeal are subject to reconciliation pursuant to 26 CFR § 1.36B -4.

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 pursuant to §A of this regulation is filed within 90 days of the receipt of the notification specified in Regulation .04A of this chapter, in one of the following methods:

(1) Postmarked, delivered in person, or faxed to the Office of Administrative Hearings;

(2) Postmarked, emailed, telephoned, or faxed to the Exchange;

(3) Postmarked, telephoned, or faxed to the Consolidated Services Center;

(4) Postmarked, delivered in person, telephoned, or faxed to the delegate agency; or

(5) Postmarked, delivered in person, telephoned, or faxed to the Department's Office of Health Services.

E. Dismissal.

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

(a) Withdrawn in writing, either electronically or in hard copy; 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; and

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

Md. Code Regs. 14.35.11.05

Regulation .05 adopted effective 42:11 Md. R. 726, eff.6/8/2015