Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.15 - Fair Hearings Of Integrated Care Networks

Current through Register Vol. 42, No. 9, June 28, 2024
(1) An integrated care network (ICN) that has
			 been sanctioned by the Medicaid Agency in accordance with Alabama Medicaid
			 Administrative Code Chapter 560-X-64 may request a fair hearing.
(2) An ICN's request for a fair hearing with
			 the Medicaid Agency relating to the imposition of a sanction must be in writing
			 and must be filed with the Medicaid Agency within thirty (30) calendar days of
			 the date of the sanction notice. The written request shall include a statement
			 of the factual and/or legal basis for the ICN's dispute or claim and a
			 statement of the relief or action sought. The Medicaid Agency will not accept
			 requests for fair hearings that are outside the filing deadline. The ICN may
			 submit the written request for fair hearing to the Medicaid Agency by mail,
			 hand-delivery, facsimile or electronic mail, and the request must be received
			 by the Medicaid Agency on or before the filing deadline.
(3) Upon filing a written request for a fair
			 hearing, the ICN may also request an informal conference with the Medicaid
			 Agency to seek a resolution of the ICN grievance.
(4) If the ICN grievance is not resolved
			 through informal conference with the Medicaid Agency, the ICN grievance shall
			 be reviewed in a fair hearing shall be conducted before an impartial hearing
			 officer in accordance with the requirements for contested case proceedings
			 under the Alabama Administrative Procedure Act, Section
			 41-22-1 et seq. of the
Code of Ala. 1975
. The hearing authority for all fair
			 hearings of ICN sanctions shall be the Commissioner of the Medicaid Agency, who
			 shall appoint one or more hearing officers to conduct fair hearings and submit
			 findings and recommendations to the Commissioner for final decision on each ICN
			 grievance. The hearing officer shall not have been involved in any way with the
			 ICN sanction in question.
(5) A
			 fair hearing shall be impartially conducted and held at the Medicaid Agency's
			 central office in Montgomery. Written notice of the date, time, place and
			 nature of the fair hearing shall be sent by certified mail to the ICN's address
			 of record and may also be communicated by email or facsimile transmission by
			 the Director, Hearings of the Medicaid Agency, or the designated hearing
			 officer, at least ten (10) calendar days before the hearing is to be held. The
			 notice shall comply with the requirements of Section
			 41-22-12(b) of
			 the
Code of Ala. 1975
.
(6) The ICN may be represented at the fair
			 hearing by legal counsel at its own expense. The ICN may call witnesses and may
			 examine witnesses called by other parties.
(7) The Medicaid Agency shall be responsible
			 for payment of the hearing officer(s) fees and expenses and any court
			 reporter's fees and expenses related to the fair hearing.
(8) All fair hearings shall be conducted in
			 accordance with the provisions of Sections
			 41-22-12 through
			 41-22-19 of the
Code
			 of Ala. 1975
, unless otherwise noted in this rule. Within thirty
			 (30) calendar days of the conclusion of the hearing, the findings and
			 recommendations of the hearing officer shall be submitted to the Commissioner
			 of the Medicaid Agency, who shall make a final decision within thirty (30)
			 calendar days of the recommendation. The Medicaid Agency shall promptly send a
			 copy of the final decision to the ICN's address of record by certified
			 mail.
(9) The ICN may seek judicial
			 review of the final decision of the Medicaid Agency in accordance with the
			 provisions of Sections
			 41-22-20 and
			 41-22-21 of the
Code
			 of Ala. 1975
.
(10)
			 Nothing in this rule is intended to create or establish new causes of action in
			 any court. Nothing in this rule shall be construed as a waiver of any
			 sovereign, qualified, or any other type of immunity.
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-6-220 et
				  seq.