<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 10.67.10.02" title_num="10" subtitle_num="67" chapter_num="10" heading="Appeal.">
  <paragraph num="A.">
    <text>From the decisions set forth in §B(1)—(8) of this regulation, an MCO may exercise the appeal rights set forth in §C of this regulation.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The following Department decisions are appealable by the MCO or MCO applicant:</text>
    <paragraph num="(1)">
      <text>Denial of an entity’s completed application to become an MCO;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Decision to terminate the MCO's participation in the Maryland Medicaid Managed Care Program;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Decision to impose a fine valued at $50,000 or more on the MCO as described in Regulation .01 of this chapter;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Order that the MCO is impaired or in “hazardous financial condition”;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>An adverse decision by the IRO as described in COMAR 10.67.13.08;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The denial of a hepatitis C payment as described in COMAR 10.67.04.19;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Overpayments recovered by the Department as described in COMAR 10.67.07.01; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Remittances to the Department as described in COMAR 10.67.04.19-5.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>An MCO may appeal a decision listed in §B of this regulation to the Office of Administrative Hearings as specified in COMAR 10.01.03 and COMAR 10.09.36.09.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The parties to an appeal to the Office of Administrative Hearings under §C of this regulation are the Department and the MCO. The enrollee is not a party at this hearing.</text>
  </paragraph>
  <paragraph num="E.">
    <text>The following sanctions shall take effect immediately and are not subject to stay during the pendency of an appeal:</text>
    <paragraph num="(1)">
      <text>Any fines imposed;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Any full or partial withhold of the capitation payment;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Any remittances to the Department as described in COMAR 10.67.04.19-5; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Any overpayments recovered by the Department as described in COMAR 10.67.07.01.</text>
    </paragraph>
  </paragraph>
</regulation>