Chapter 10. Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification
Regulation .01 Scope.LinkCopy Citation
A.
This chapter applies to contested case hearings delegated by the Board to the Office in accordance with State Government Article, §10- 205(a)(1)(ii), Annotated Code of Maryland.
B.
Except as explicitly stated in this chapter, COMAR 28.02.01 governs the conduct of a hearing before the Office of Administrative Hearings.
C.
Determinations entitled to contested case appeals. This chapter applies only to the appeal of an Exchange determination regarding:
(1)
Suspension of SHOP Exchange producer authorization;
(2)
Revocation of SHOP Exchange producer authorization;
(3)
Renewal of SHOP Exchange producer authorization;
(4)
Suspension of Individual Exchange producer authorization;
(5)
Revocation of Individual Exchange producer authorization;
(6)
Renewal of Individual Exchange producer authorization; and
(7)
Denial of Individual Exchange initial navigator certification.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Administrative law judge” has the meaning set forth under COMAR 28.02.01.02B(1).
(2)
“Board means the Maryland Health Benefit Exchange Board of Trustees.
(3)
Contested Case.
(a)
Contested case” has the meaning stated in State Government Article, §10-202(d), Annotated Code of Maryland.
(b)
“Contested case” includes a proceeding:
(i)
Arising out of a determination made by the Board;
(ii)
Regarding an authorization, certification, or permit issued by the Exchange; or
(iii)
Arising out of any act of or failure to act by the Board, involving an authorization or a certification issued by the Exchange, that aggrieves a person.
(c)
“Contested case” does not include any other quasi-legislative hearing.
(4)
Determination.
(a)
“Determination” means a decision by the Board that requires the Board to provide the opportunity for a hearing to a person aggrieved by the decision.
(b)
“Determination” includes:
(i)
A decision as to whether a person against whom an administrative complaint has been received violated a law, regulation, or order; and
(ii)
An order issued pursuant to the Board’s authority.
(5)
“Exchange” means the Maryland Health Benefit Exchange.
(6)
“Executive Director” means the Executive Director of the Maryland Health Benefit Exchange, appointed pursuant to Insurance Article, §31-105, Annotated Code of Maryland.
(7)
“Hearing officer” means the Board or the Board’s authorized designee.
(8)
“Maryland Health Benefit Exchange” has the meaning set forth under Insurance Article, §31-101(e), Annotated Code of Maryland.
(9)
“Office” means the Office of Administrative Hearings.
(10)
“Person” has the meaning set forth under COMAR 28.02.01.02B(12).
Regulation .03 Request for Hearing — In General.LinkCopy Citation
A.
Scope. This regulation applies to all requests for a hearing permitted under Regulation .01C of this chapter.
B.
A person aggrieved may request a hearing by submitting a written statement to the Office, signed by the requesting person and containing the following information:
(1)
The action or nonaction of the Exchange causing the person requesting the hearing to be aggrieved;
(2)
The facts related to the incident or incidents about which the person requests the Exchange to act or not to act; and
(3)
The ultimate relief requested.
C.
Request to Be Received Within 30 Calendar Days.
(1)
The request shall be received by the Office within 30 days of the date of the letter notifying the party of the Exchange’s action, intention to act, or failure to act.
(2)
In calculating the 30-day period, the date of the letter notifying the party of the Exchange’s action, intention to act, or failure to act is not included.
(3)
The end of a day is considered to be 11:59 p.m. Eastern Time.
(4)
The last day of the 30-day period is included unless it is a Saturday, Sunday, legal holiday, or day that the Office of Administrative Hearings is closed for a part of the day.
(5)
If the last day of the 30-day period is a Saturday, Sunday, legal holiday, or a day that the Office of Administrative Hearings is closed for a part of the day, the 30-day period runs until the end of the next day which is not a Saturday, Sunday, legal holiday, or day that the Office of Administrative Hearings is closed for a part of the day.
(6)
Intermediate Saturdays, Sundays, legal holidays, and days that the Office of Administrative Hearings is closed for a part of the day shall be counted toward the 30-day period.
D.
Upon receipt of a proper request, the Office shall grant a hearing unless, in viewing the facts set forth by the person making the request, in the light most favorable to that person, the Office determines that:
(1)
The Office has no authority to take action;
(2)
The request does not contain the information required by these regulations;
(3)
The request is untimely; or
(4)
The request is moot.
Regulation .04 Delegation of Authority.LinkCopy Citation
A.
Scope. This regulation applies to all requests for a hearing permitted under Regulation .01C of this chapter.
B.
In accordance with State Government Article, §10-205(a)(1)(ii), Annotated Code of Maryland, the Board delegates to the Office the authority to:
(1)
Conduct a contested case hearing; and
(2)
Issue:
(a)
Final findings of fact and conclusions of law; and
(b)
A proposed order.
C.
The Board may revoke all or part of a delegation of authority to preside over a hearing if:
(1)
The case:
(a)
Involves novel or unanticipated factual or legal issues;
(b)
Has significant social, fiscal, or legal issues;
(c)
Involves policy issues; or
(d)
Requires further investigation; or
(2)
The Board determines that revocation of all or part of the delegation of authority is otherwise in the public interest.
D.
Procedure for Revocation.
(1)
The Board shall provide written notice of a revocation of hearing authority to all parties and the entity conducting the contested case hearing under State Government Article, §10-205(a)(1)(ii), Annotated Code of Maryland.
(2)
The written notice shall contain a brief statement of the reason for the revocation.
(3)
Delegation of authority to hear a contested case may be revoked at any time before the earlier of the:
(a)
Issuance of a ruling by the entity delegated authority to conduct a contested case hearing under §A of this regulation on a substantive issue; or
(b)
Taking of oral testimony from the first witness.
(4)
The Board shall specify whether all or part of the delegation to hear a contested case has been revoked.
(5)
If only part of the delegation has been revoked, the Board shall specify in the written notice of revocation the portions of the contested case for which the delegation has been revoked.
(6)
On revocation of the delegation, the Board shall:
(a)
Cause further investigation;
(b)
Set the contested case for a hearing with the Board or the Board's designee acting as the hearing officer as permitted under State Government Article, §10-205(a)(1)(ii), Annotated Code of Maryland; or
(c)
Dismiss the contested case.
Regulation .05 Service of Notices, Decisions, Orders, and Other Documents.LinkCopy Citation
A.
The Office shall provide notice of a hearing, decisions, orders and other documents issued by the Office pursuant to State Government Article, §§10-208 and 10-209, Annotated Code of Maryland.
B.
A hearing may be rescheduled if there is satisfactory showing that the notice was sent not less than 30 calendar days before the hearing, or upon agreement of all parties.
Regulation .06 Default Orders.LinkCopy Citation
A.
With respect to hearings conducted on behalf of the Exchange, a hearing officer may issue a proposed default order against a party other than the Exchange that, after receiving proper notice, fails to appear at a hearing if:
(1)
Notice is issued by the Office, and the party failing to appear is the person against whom the notice was issued; or
(2)
In any other contested case hearing, the party failing to appear is the person that requested the hearing.
B.
In a hearing arising out of a notice or determination issued by the Exchange, the proposed default order shall:
(1)
State the facts supporting the finding of proper notice to the person against whom the notice or determination was issued;
(2)
Adopt the facts and violations of law as alleged by the Exchange in its notice or determination as if by admission of the person against whom the charging document, order or notice was issued; and
(3)
Adopt the sanction requested by the Exchange at the hearing.
C.
The hearing officer shall serve the proposed default order directly on the parties by certified mail.
D.
Within 15 calendar days after service of a proposed default order, the party in default may submit to the Board a written motion:
(1)
Requesting that the proposed default order be vacated or modified; and
(2)
Stating the grounds for the request.
E.
If the Board finds that there is:
(1)
Good cause to excuse the default, the Board may:
(a)
Vacate or modify the default order; and
(b)
Schedule the case for further appropriate proceedings; or
(2)
No good cause to excuse the default, the Board shall:
(a)
Deny the motion; and
(b)
Affirm the proposed default order as the final order.
Regulation .07 Administrative Decisions.LinkCopy Citation
A.
Contents. The hearing officer shall submit to the Board a decision that contains:
(1)
Final findings of fact and conclusions of law; and
(2)
A proposed order.
B.
Effect of Regulations, Bulletins, and Preexisting Policies. In making a decision, the Office is bound by any regulation, bulletin, final order, or settled and preexisting policy of the Board to the same extent that the Board is or would have been bound if the Board were hearing the case.
C.
Distribution of Decision. The Office shall send its decision directly to the parties and the Board.
Regulation .08 Exceptions.LinkCopy Citation
A.
On receipt of a decision that contains proposed findings of fact, proposed conclusions of law, or a proposed order, the parties affected have:
(1)
20 calendar days after receipt to request to present argument, file exceptions to the proposed order with the Board, or both of these; or
(2)
10 calendar days to:
(a)
File a written request for a transcript, at the party’s own expense, with the Board in order to file exceptions; or
(b)
File with the Board a copy of that party's written request to its stenographer, at the party’s own expense, for the party's preparation of a transcript based on its own record of the testimony in order to file exceptions.
B.
Receipt under §A of this regulation is presumed to occur 3 calendar days after the mailing of the proposed order.
C.
Filing Exceptions After Receipt of Transcript.
(1)
If a party requests a transcript under §A(2) of this regulation, the party shall have 30 calendar days after the filing of the transcript to file a request to present argument, exceptions, or both of these with the Board.
(2)
Unless extended by order of the Board, the party requesting the transcript shall file the transcript with the Board within 60 calendar days after the date on which the transcript was requested.
D.
Exceptions shall be in writing unless specified otherwise by the Board.
E.
If a party elects not to offer argument or file exceptions, another party may not raise the defense of failure to exhaust this administrative remedy on appeal to circuit court.
F.
If a party requests the opportunity to offer argument, the Board shall grant the request and allow the party to present argument to a majority of the Board.
G.
The record before the Board for the exceptions shall consist of:
(1)
The Office’s findings and conclusions, including the findings of fact, conclusions of law, and proposed order;
(2)
Any exceptions filed by a party;
(3)
Any response to exceptions filed by a party;
(4)
Any evidence submitted by a party;
(5)
Notice to the parties of the hearing;
(6)
Any documentary evidence admitted into evidence by the Office; and
(7)
The transcript of the hearing before the Office, if requested and filed by one of the parties or the Board.
H.
Transcripts.
(1)
A party who desires to have the transcript made part of the record shall, at the party's own expense, file three copies of the transcript, or its relevant portions, with the Board on receipt of the transcript.
(2)
If a transcript has already been prepared, the Board shall make the transcript part of the record in the contested case.
(3)
If a transcript is prepared based on the Office’s record of the testimony and a transcript is prepared based on a party's own record of the testimony, the transcript based on the Office’s record of the testimony is:
(a)
The official transcript; and
(b)
Controlling in the event of any conflict between the two transcripts.
(4)
If the transcript is not filed or otherwise made part of the record in the contested case, parties may not refer in their exceptions to any testimony before the Office not incorporated into the Office’s findings and conclusions.
(5)
If all parties agree that the questions presented for review to the final decision maker can be determined without an examination of the entire transcript, the parties may file a statement showing how the questions arose and setting forth the facts or allegations that are essential to a determination of those issues.
Regulation .09 Final Order Following Proposed Decision.LinkCopy Citation
A.
Issuance. After consideration of the Office’s proposed order, and any exceptions filed by the parties, the Board shall issue a final order or a remand order.
B.
Effect of Proposed Order. In reviewing the Office’s proposed order, the Board is:
(1)
Bound by the findings of fact that are supported by competent, material, and substantial evidence; and
(2)
Not bound by any legal analysis, conclusions of law, or proposed order.
C.
Types of Action by the Board. The Board may affirm, reverse, or modify the findings of fact that are supported by competent, material, and substantial evidence, conclusions of law, or proposed order, or remand the case to the Office for further proceedings by setting forth, with particularity, the basis for the Board’s reversal, modification, or remand.
D.
Procedure When Case Remanded. If the Board remands the case for further proceedings, the Board may:
(1)
Refer the case back to the Office; or
(2)
Retain the case to be heard by the Board.
E.
Rehearing. The Board may, on the Board's own motion, hold a rehearing.
F.
Service of Order. The Board shall serve a copy of the final order or remand order on the parties, the parties' attorneys of record, and the entity by first-class mail.
G.
Effect of Summary Affirmance.
(1)
If the Board issues a final order that summarily affirms the proposed order of the Office without discussing the facts and legal issues and without expressly adopting the Office’s legal analysis and conclusions of law, neither the final order nor the proposed order is precedent within the rule of stare decisis.
(2)
Notwithstanding §G(1) of this regulation, a final order of the Board that summarily affirms the proposed order of the Office without discussing the facts and legal issues and without expressly adopting the Office’s legal analysis and [proposed] conclusions of law may be cited and relied on in a proceeding before the Board, the Office, or a court:
(a)
When relevant under the doctrine of the law of the case, res judicata, or collateral estoppel; or
(b)
In any subsequent disciplinary proceeding involving a party to the final order.
(3)
If a party appeals from a final order of the Board that summarily affirms the proposed order of the Office, in addition to filing the final order of the Board with the court in which the appeal is pending, the Board also shall file a copy of the proposed order of the Office.
Regulation .10 Decisions.LinkCopy Citation
The Board shall sign the final order, and the order is effective when issued unless a different date is specified in the decision. A copy of the final order shall be filed with the Exchange and served on all parties to the hearing.
Regulation .11 Mistake or Error in the Final Order.LinkCopy Citation
The Board may correct an order if, upon review, the final order was issued as a result of fraud, mistake, or inadvertence or contains a clerical error.
Regulation .12 Judicial Review.LinkCopy Citation
A party adversely affected by a final decision of the Board, or the entity delegated authority to make the final decision, may obtain judicial review of the decision as provided by law.
Chapter annotations
Authority: Insurance Article, §§31-106(c)(1)(iv), 31-112, and 31-113; State Government Article, Title 10, Subtitle 2; Annotated Code of Maryland
History: Effective date: June 8, 2015 (42:11 Md. R. 725)
History: Regulation .01C amended effective November 29, 2021 (48:24 Md. R. 1025)
History: Chapter revised effective July 10, 2023 (50:13 Md. R. 513)
History: Regulation .01C amended effective August 18, 2025 (52:16 Md. R. 848)