Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.5 - FAIR HEARINGS AND CONTESTED CASE PROCEEDINGS › Subchapter 37.5.3 - Formal and Informal Hearing and Appeal Procedures › Rule 37.5.310 - ADMINISTRATIVE REVIEW AND FAIR HEARING PROCESS FOR MEDICAL ASSISTANCE PROVIDERS

Current through Register Vol. 13, July 5, 2024
(1) The following
				administrative review and fair hearing process applies to all medical
				assistance providers that are aggrieved by an adverse action of the department,
				except medical assistance providers appealing eligibility determinations as a
				real party in interest.
(2) A
				medical assistance provider, other than a medical assistance provider appealing
				an eligibility determination as a real party in interest, aggrieved by an
				adverse action of the department may request an administrative review. The
				request must be in writing, must state in detail the provider's objections, and
				must include any substantiating documents and information which the provider
				wishes the department to consider in the administrative review. The request
				must be mailed or delivered to the Department of Public Health and Human
				Services, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and should be
				addressed or directed to the division of the department that issued the
				contested determination. The request for administrative review must be received
				by the department within 30 days of mailing of the department's written
				determination.
(a) Within the 30 days a
				provider may request in writing an extension of up to 15 days for submission of
				a request for administrative review. The department may grant further
				extensions for good cause shown. Requests for further extensions must be in
				writing, must be received by the department within the period of any previous
				extension, and must demonstrate good cause for the extension.
(b) The provider may also request a
				conference as part of the administrative review. If the provider requests an
				administrative review conference, the conference must be held at a time
				scheduled by the department as provided in ARM
				37.5.318(3) through
				(3)(c)(ii). If a provider requests a
				conference as part of the administrative review, any substantiating materials
				the provider wishes the department to consider as part of the review may be
				submitted no later than the time of the conference. The conference may be
				conducted by the department or its designee and shall be based on the
				department's records and determination and the provider's written objections
				and substantiating materials, if any.
(c) No later than 60 days following receipt
				of the written objections and substantiating materials, if any, or the
				conference, whichever is later, the department must mail a written
				determination concerning the provider's objections and substantiating materials
				and the position the department takes concerning the determination.
(d) A provider must exhaust in a timely
				manner the administrative review process provided in this rule before
				requesting a fair hearing. A provider that has not exhausted the administrative
				review process, including a provider that fails to timely request an
				administrative review, is not entitled to a fair hearing before the department
				or the board.