Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 191 - MENTAL HEALTH AND MENTAL RETARDATION - GENERAL › Chapter 40 - REQUIREMENTS FOR FUNDING SERVICES › Section 191-40-IV - APPEALS

Current through 2024-29, July 17, 2024
A. Informal review
Providers and persons who have been denied payment for
				  services may request a review by the Program Director overseeing the service.
				  The request must be made in writing to the Program Director and must arrive
				  within ten (10) working days of the denial of payment. The request for review
				  shall state the reasons for the request and shall be accompanied by any
				  supporting documentation. Supporting documentation must include that described
				  at III.A. above
After receiving the request for review, the Program Director
				  shall promptly review the request, the material submitted in support of the
				  request and any other material available to the Program Director and relevant
				  to the decision. Within thirty (30) working days of the receipt of the request,
				  the Program Director shall respond to the provider and person in writing,
				  stating the determination of the review and the reason(s) for the
				  determination.
B.
				Administrative Hearing; Recommended Decision
The provider or person who receives an adverse determination
				  of an informal review may request an administrative hearing by submitting a
				  written request therefore to the Commissioner no later than thirty (30)
				  calendar days following the date of the Program Director's decision. The issues
				  in the administrative hearing and in any appealstherefrom shall be limited to
				  the issues raised by the provider or person in writing in the informal review.
				  A provider or person who fails to submit a request for informal review shall be
				  deemed to have waived the right to an administrative hearing and to any further
				  review of the decision.
The Commissioner shall forward the request for administrative
				  hearing to an independent hearing officer or independent hearings unit within
				  seven (7) calendar days of receipt. At least twenty (20) calendar days before
				  the administrative hearing, the hearing officer or hearings unit shall notify
				  the provider or person of the date, time and place of the hearing and the name
				  of the hearing officer. The hearing shall be held in conformity with the Maine
				  Administrative Procedure Act, 5 MRSA9051
et seq
. The provider
				  or person may be represented by legal counsel at the hearing and may request
				  the issuance of subpoenas to compel other persons to appear at the hearing to
				  testify on relevant issues. An electronic recording or verbatim transcript must
				  be made of any administrative hearing pursuant to this section.
Unless otherwise agreed by the parties, the hearing officer
				  must issue, and file with the Commissioner, a written recommended decision with
				  findings of fact within ten (10) calendar days of the close of the
				  hearing.
C. Final Decision
				of Commissioner
Any recommended decision of a hearing officer is subject to
				  further review by the Commissioner, who must issue a final decision adopting,
				  modifying, or rejecting the hearing officer's recommended decision. The
				  Commissioner must issue the final decision no later than thirty (30) calendar
				  days from the date of receipt of the recommended decision. Parties may submit
				  written memoranda to the Commissioner within ten (10) calendar days of the date
				  of the recommended decision. The recommended decision of a hearing officer
				  shall be deemed adopted by the Commissioner if no final decision is issued
				  within thirty (30) calendar days from the date of receipt of the recommended
				  decision.
The Commissioner's decision constitutes final agency action
				  for purposes of judicial review under the Maine Administrative Procedure
				  Act.