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<regulation prefix="Regulation" num=".09" citation="COMAR 10.09.36.09" title_num="10" subtitle_num="09" chapter_num="36" heading="Filing Appeal.">
  <paragraph num="A.">
    <text>Source of Appeals.</text>
    <paragraph num="(1)">
      <text>A provider may file an appeal from a proposed Program action to:</text>
      <paragraph num="(a)">
        <text>Suspend the provider from the Program;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Withhold payment by the Program;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Recover an overpayment;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Remove the provider from the Program; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Disqualify the provider from future participation in the Program, either as a provider or as a person providing services for which Program payment will be claimed.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A provider shall submit an appeal according to:</text>
      <paragraph num="(a)">
        <text>COMAR 10.01.03;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Health-General Article, §§2-201—2-207, Annotated Code of Maryland; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>COMAR 28.02.01.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A provider may not file an appeal from a Program action to terminate the provider when that action is the result of either:</text>
      <paragraph num="(a)">
        <text>Termination of the provider or an owner by the federal government or another state Medicaid agency pursuant to 42 CFR §445.416; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Suspension or termination of the provider’s license or certificate by their respective licensing or certification authority.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Request for a Hearing.</text>
    <paragraph num="(1)">
      <text>An appeal of a proposed Program action shall be filed in writing with the Program within 30 days of the date of the notice of the proposed Program action. The Program shall make reasonable accommodation if a provider cannot submit a written request because of a disability.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Program shall immediately forward a written appeal request to the Office of Administrative Hearings.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Office of Administrative Hearings shall:</text>
      <paragraph num="(a)">
        <text>Promptly acknowledge any appeal; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Notify the provider and the Program in writing of the date, time, and place of the hearing.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Effective Date. The proposed Program action shall be effective on:</text>
    <paragraph num="(1)">
      <text>The date of the proposed Program action notice if the Program:</text>
      <paragraph num="(a)">
        <text>Determines that the provider poses an imminent threat to public health, safety, or welfare that requires emergency action; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Notifies the provider of this determination in the proposed Program action notice;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The date specified in the proposed Program action notice if the provider:</text>
      <paragraph num="(a)">
        <text>Does not request a hearing within 30 days of the date of the notice of the proposed Program action; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Withdraws in writing or abandons a request for a hearing before the effective date of the proposed Program action;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The first payment date following the date of the Program action notice if the Program action involves withholding payment to the provider because the Program discovered an overpayment to the provider;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The date the administrative law judge renders a decision in favor of the Program if the provider:</text>
      <paragraph num="(a)">
        <text>Fails to timely file exceptions to the administrative law judge's decision with the Secretary pursuant to §D of this regulation; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Withdraws in writing or abandons a request for an exceptions hearing before the date of the exceptions hearing; or</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>The date the Secretary renders a decision in favor of the Program pursuant to COMAR 10.01.03 if any party files exceptions with the Secretary in accordance with §E(1) of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A Program determination to suspend payments due to a credible allegation of fraud shall be effective immediately unless the Department determines, consistent with 42 CFR §455.23, that a good cause exception to immediate suspension exists.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Exceptions and Outcomes.</text>
    <paragraph num="(1)">
      <text>A party may seek additional administrative review of the administrative law judge's decision by filing in writing exceptions with the Secretary within 30 days of the date of the administrative law judge's decision pursuant to COMAR 10.01.03.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the Secretary's decision is favorable to the Program, the Program may:</text>
      <paragraph num="(a)">
        <text>Immediately implement the proposed Program action; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Institute recovery procedures against the provider to recoup the cost of any payments made to the provider to the extent the payments were made solely because the provider was permitted to continue to submit claims to the Department because of §C(5) of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>If the proposed Program action was effective on the date of the notice as provided for in §B(1) of this regulation, the Program shall authorize corrected payments or relief retroactive to the date of the notice if:</text>
      <paragraph num="(a)">
        <text>The Secretary's decision is favorable to the provider; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Program grants the provider the relief the provider requests before the Secretary's decision.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Further Appeals. The provider may seek additional administrative review of the Secretary's decision as provided in Health-General Article, §§2-206 and 2-207, Annotated Code of Maryland, and subsequent judicial review as provided in State Government Article, §10-215, Annotated Code of Maryland.</text>
  </paragraph>
</regulation>