<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09" citation="COMAR 14.35.11.09" title_num="14" subtitle_num="35" chapter_num="11" heading="Findings, Timing of Decision, and Effect of Decision.">
  <paragraph num="A.">
    <text>Findings.</text>
    <paragraph num="(1)">
      <text>The administrative law judge shall:</text>
      <paragraph num="(a)">
        <text>Prepare a written summary of findings and conclusions based exclusively on the record; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Make a decision based on his findings and conclusions.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The summary of findings and conclusions shall:</text>
      <paragraph num="(a)">
        <text>State the evidence, policies, regulations, or laws upon which the administrative law judge’s decision is based; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide written notice to the appellant that, if they are not satisfied with the decision, they may seek additional appeals as specified in §C of this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Timing of Hearing Decision.</text>
    <paragraph num="(1)">
      <text>The administrative law judge shall forward to the appellant, and to appellant’s authorized representative, if applicable, a copy of the findings, conclusions, and decision within 90 days from the date the appellant or appellant’s representative filed a request for a fair hearing pursuant to Regulation .05A of this chapter.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the date of the fair hearing is postponed at the appellant’s request, the length of the postponement may not be counted as part of any of the time period specified in §B(1) of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Appeal Rights.</text>
    <paragraph num="(1)">
      <text>Any party may seek judicial review as provided in State Government Article, §10-222, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An administrative law judge’s decision:</text>
      <paragraph num="(a)">
        <text>Related to Program benefits:</text>
        <paragraph num="(i)">
          <text>Shall be implemented immediately, if adverse to the appellant.</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>If favorable to the appellant, shall be implemented retroactively to the date the incorrect action was taken; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Related to eligibility for enrollment in a qualified health plan, advance payments of the premium tax credit, cost-sharing reductions, or State-based subsidies shall be implemented in accordance with 45 CFR §155.545(c)(1).</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>To the extent an administrative law judge’s decision upholds the determination or redetermination of the Exchange with respect to an applicant for eligibility for enrollment in a qualified health plan or for an insurance affordability program described in Regulation .02B(10)(d) or (e), the applicant may appeal to the United States Department of Health and Human Services pursuant to 45 CFR §155.520(c).</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Effect of Decision.</text>
    <paragraph num="(1)">
      <text>When the decision requires action by the Department, the Exchange shall notify the Department.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>When the decision is favorable to the appellant, or when the Exchange grants the appellant the relief the appellant requests before the decision, the Exchange, where applicable, shall authorize corrected payments or relief retroactive to the date the incorrect action was taken and redetermine eligibility for household members whose eligibility may be affected by the appeals decision.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Any payment or action by the Exchange under §D(2) of this regulation may not constitute a waiver of the Exchange’s sovereign immunity from suit.</text>
    </paragraph>
  </paragraph>
</regulation>