Chapter 09. Procedures for Hearing Before the Hospital Appeal Board and Nursing Home Appeal Board

The following terms have the meanings indicated.

Terms Defined.

An opportunity for a hearing shall be provided to any hospital or nursing home that requests review of a final cost settlement by filing a written notice of appeals with the Board not later than 30 days after receipt of the notice of final cost settlement. This notice shall be filed in a format prescribed by the Board.

The notice of appeal shall be delivered in person to the Board at the address designated by the notice of final cost settlement or shall be sent by registered or certified mail, return receipt requested.

The notice of appeal shall describe with specificity the particular cost adjustments appealed by the provider as well as the fiscal years in which those adjustments have been applied.

The provider may elect one of the following types of procedures:

The procedures provided in §D(3) of this regulation will be followed if the Medical Assistance Program objects in writing to the election of a procedure provided for in §D(1) or (2) of this regulation within 10 working days of receipt of the election.

The Board shall prescribe the format in which the provider may elect the type of procedure desired with the submission of an appeal. This election shall be binding and constitutes a waiver of any other form of hearing before the Board for that particular appeal unless the Medical Assistance Program objects in the manner provided in §E of this regulation.

After receipt of a notice of appeal with an election by the provider of a full evidentiary hearing, the Board shall schedule a prehearing conference.

The prehearing conference shall be presided over by a member of the Board or by a person designated by the Board.

The prehearing conference may be conducted either in person or by telephone conference call.

The presiding officer shall issue a prehearing order after the conference specifying the:

A record shall be made of the prehearing conference by the officer in charge.

All prehearing matters, including requests for postponements, shall be addressed to and determined by the officer who presides at the prehearing conference.

The hearing shall be conducted by the Board, or by a person or agency designated by the Board.

The rules of evidence in all hearings shall be those set forth in State Government Article, §§10-213 and 10-214, Annotated Code of Maryland.

Any party may submit evidence, examine and cross-examine witnesses, and file objections, exceptions, and motions. When a party is represented by counsel, all submissions of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by counsel.

The presiding officer or officers at the hearing may examine any witness called by any party or may call as a witness any persons in attendance at the hearing.

Testimony taken at the hearing shall be under oath. The oath shall be in the following form: “Do you solemnly promise and affirm under the penalties of perjury that the testimony you are about to give in this matter now pending before the Board shall be the truth, the whole truth, and nothing but the truth?”

If a party fails to appear at the hearing after due notice, the presiding officer or officers at the hearing may reschedule the hearing, or dismiss the appeal, or may proceed to determine the issues appealed on the available record.

The presiding officer or officers shall prepare an official record of the hearing which shall include the notice of appeal, the presiding officer or officers' record of the prehearing conference, the prehearing order, a stenographic transcription of any oral evidence presented at the hearing, as well as any pleadings, written testimony, exhibits, and other memoranda or materials filed in the proceedings.

If the hearing is not conducted before a Board consisting of three members as provided in COMAR 10.09.10.34, 10.09.92.10, 10.09.93.12, and 10.09.95.12, the presiding officer or officers at the hearing shall issue recommendations to the Board on all of the issues appealed in the notice of appeal.

The recommendations shall be in writing and shall include findings of fact and conclusions of law.

A copy of the recommendations shall be delivered or mailed promptly to each party or his attorney of record.

Within 20 days after receipt of the recommendations, any party may file exceptions with the Board from all or a portion of the recommendations and may present argument before the Board as provided in State Government Article, §10-216, Annotated Code of Maryland, or waive oral argument and have the Board proceed only on the party's written exceptions. If exceptions to the recommendations are filed beyond the 20 day limit, these exceptions may not be considered by the Board when making its decision.

If the hearing was presided over by the full Board, or after consideration by the full Board of the recommendations and exceptions to the recommendations and any argument in support of them, the Board shall issue a decision including findings of fact and conclusions of law on all issues appealed in the notice of appeal.

The decision of the Board shall be implemented immediately unless otherwise specifically indicated in the decision.