Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › RECONSIDERATION AND REVIEW BY THE SECRETARY › Section 41.212 - Review of Bureau determinations

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A determination of the Bureau will be
					 deemed the final adjudication of the Department effective upon expiration of
					 the 30-day time period specified in subsection (b) unless an aggrieved party
					 requests review by the Secretary within that 30-day time period.
(b) A request for review shall be filed
					 within 30 days of the mailing date of the Bureau determination. An untimely
					 request for review will be dismissed as of course unless the filing party can
					 satisfy the requirements of §
											41.33 (relating to appeals nunc
					 pro tunc).
(c) A request for review
					 must be in writing, state concisely the alleged errors in the Bureau
					 determination and identify the particular relief sought. If the party
					 requesting review is seeking relief by reason of matters that have arisen since
					 the hearing and Bureau determination, or by reason of a matter that would arise
					 from compliance with the Bureau determination, the party shall specifically
					 identify those matters in its request.
(d) If an aggrieved party timely requests
					 review of a Bureau determination, the Secretary may enter an order granting or
					 denying the request for review within 30 days of receipt of the request. No
					 party has a right to have a Bureau determination reviewed by the Secretary, but
					 only a right to request this review. The decision to grant or deny a request
					 lies within the discretion of the Secretary.
(e) If the Secretary enters an order denying
					 a request for review within 30 days of receipt of the request, the Bureau's
					 determination will be deemed the final adjudication of the Department effective
					 on the date of the order denying the request for review.
(f) If the Secretary fails to act on a
					 request for review within 30 days of receipt of the request, the request for
					 review will be deemed denied. The Bureau's determination will be deemed the
					 final adjudication of the Department effective on the date on which the request
					 for review is deemed denied.
(g)
					 Answers to a request for review will not be considered by the Secretary unless
					 the Secretary has granted review. If, and to the extent the Secretary has
					 granted review, a response in the nature of an answer may be filed by a party,
					 other than the party requesting review. The response must be confined to the
					 issues upon which the Secretary has granted review.
(h) If the Secretary grants review, the
					 Secretary will enter a final order within 180 days of the date of the order
					 granting review. The final order may affirm, reverse or modify the findings of
					 fact, conclusions of law or the relief set forth in the Bureau's determination,
					 and may, to promote fairness and the proper administration of the MA Program,
					 waive compliance with program requirements.
(i) If the Secretary fails to act within 180
					 days of the order granting review, the determination of the Bureau will be
					 deemed approved by, and the final order of, the Secretary effective the date it
					 is deemed approved.
This section cited in 55 Pa. Code §
													41.5 (relating to jurisdiction of
						  the Bureau); 55 Pa. Code §
													41.191 (relating to determinations
						  and recommendations by the Bureau); 55 Pa. Code §
													41.213 (relating to review of
						  Bureau recommendations); and 55 Pa. Code §
													41.214 (relating to
						  appeals).