<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".34" citation="COMAR 10.09.10.34" title_num="10" subtitle_num="09" chapter_num="10" heading="Appeal Procedures.">
  <paragraph num="A.">
    <text>Except as provided for in §B of this regulation, providers filing appeals from administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Nursing Home Appeal Board.</text>
    <paragraph num="(1)">
      <text>Appeals regarding rate calculations or cost report adjustments which cannot be resolved administratively go to the Nursing Home Appeal Board.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Appeal Board shall be composed of the following members:</text>
      <paragraph num="(a)">
        <text>A representative of the nursing home industry who is:</text>
        <paragraph num="(i)">
          <text>Knowledgeable in Medicare and Medicaid reimbursement principles; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Appointed by the Secretary;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>An individual who:</text>
        <paragraph num="(i)">
          <text>Is employed by the State;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Knowledgeable in Medicare and Medicaid reimbursement principles;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Did not directly participate in the field verification or desk review; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Is appointed by the Secretary; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>A third member selected by the first two members of the Board.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>When the Board is reviewing an appeal from a provider in which a Board member is employed or in which he has a financial or personal interest, the Secretary shall designate an alternate for that member.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>If the provider elects to appeal to the Appeal Board and the Appeal Board finds in favor of the provider, the Department shall initiate a claims adjustment settlement for the impacted service dates within 60 days after the notification of the findings.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The Department or any provider aggrieved by a reimbursement decision of the Appeal Board may not appeal to the Board of Review but may take a direct judicial appeal. The appeal shall be made as provided for judicial review of final decisions in the Administrative Procedure Act, §10-222, State Government Article, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>An appeal shall be filed in accordance with COMAR 10.01.09.</text>
    </paragraph>
  </paragraph>
</regulation>