reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › SUPERSEDEAS › Section 41.53 - Circumstances affecting grant or denial

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Bureau, in granting or denying a
					 supersedeas, will be guided by relevant judicial precedent. Factors to be
					 considered include the following:
(1)
					 Irreparable harm to the provider.
(2) The likelihood of the provider prevailing
					 on the merits.
(3) The likelihood
					 of injury to the public or other parties.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › INTERVENTION › Section 41.61 - Filing of petitions to intervene

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Petitions to intervene and notices of
					 intervention in a provider appeal may be filed following the filing of a
					 request for hearing but in no event later than 60 days from the filing date on
					 the provider's request for hearing, unless for extraordinary circumstances and
					 for good cause shown, the Bureau authorizes a late filing.
(b) Subsection (a) supersedes 1 Pa. Code
					 §§ 35.23,
					 35.24 and 35.39-35.41.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › ANSWERS › Section 41.71 - Answers generally

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An
					 answer to a pleading is not required.
(b) Answers to legal documents, if permitted
					 or required by this chapter, must be filed with the Bureau within 20 days after
					 the date of service of the legal document, unless either of the following
					 occurs:
(1) A different period is
					 specifically required in this chapter.
(2) For cause, the Bureau with or without
					 motion prescribes a different time, but in no case may an answer be required in
					 less than 10 days after the date of service.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › ANSWERS › Section 41.72 - Answers to petitions to intervene

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A party may file an answer to a petition
					 to intervene, and in default thereof, may be deemed to have waived an objection
					 to the granting of the petition.
(b) Answers shall be filed within 20 days
					 after the date of service of the petition, unless for cause the Bureau with or
					 without motion prescribes a different time.
(c) Subsections (a) and (b) supersede 1 Pa.
					 Code §
											35.36 (relating to answers to
					 petitions to intervene).
This section cited in 55 Pa. Code §
													41.81 (relating to consolidation
						  of provider appeals).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › CONSOLIDATION, AMENDMENT AND WITHDRAWAL OF APPEALS › Section 41.81 - Consolidation of provider appeals

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Each provider that wishes to appeal an
					 agency action shall file an individual request for hearing in its own name,
					 without joining another provider.
(b) The Bureau, on timely motion, may order
					 that a provider appeal be consolidated with one or more other provider appeals
					 if the Bureau determines that the provider appeals in question involve
					 substantially similar or materially related issues of law or fact and that
					 consolidation is otherwise appropriate.
(c) Consolidation is appropriate if it will
					 not prejudice the ability of the nonmoving party to perform adequate discovery
					 or to adequately present its claim or defense, and if it will not unduly delay
					 the adjudication of the earlier-filed matter.
(d) A provider appeal will not be
					 consolidated except upon motion filed by one or more parties.
(e) In addition to the general requirements
					 for motions in §§
											41.131-41.136 (relating to motions), a
					 motion for consolidation must include the following:
(1) Identification of the issues of law
					 raised in each provider appeal and the extent to which each is shared or
					 distinct.
(2) Identification of the
					 material facts that serve as a basis for each appeal and the extent to which
					 each of these facts is shared or distinct.
(3) Justification or advantages to support
					 consolidation.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › CONSOLIDATION, AMENDMENT AND WITHDRAWAL OF APPEALS › Section 41.82 - Amendments of requests for hearing

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Amendments to a request for hearing will
					 not be permitted except as specified in §§
											41.32(c) and
					 41.33(b)
					 (relating to timeliness and perfection of requests for hearing; and appeals
					 nunc pro tunc).
(b) Subsection (a)
					 supersedes 1 Pa. Code §§
											35.48-35.50 (relating to amendments of
					 pleadings generally; amendments to conform to the evidence; and directed
					 amendments).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › CONSOLIDATION, AMENDMENT AND WITHDRAWAL OF APPEALS › Section 41.83 - Withdrawal of provider appeals

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A provider may withdraw or end its
					 provider appeal prior to adjudication by one of the following:
(1) The provider notifies the Bureau in
					 writing that it is withdrawing its provider appeal.
(2) The parties to a provider appeal sign a
					 written stipulation of settlement in which the provider agrees to withdraw the
					 provider appeal.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › WAIVER AND EXPEDITED DISPOSITION › Section 41.91 - Waiver of hearings

Current through Register Vol. 54, No. 28, July 13, 2024
A hearing need not be held if one of the following
						occurs:
(1) The provider waives its
					 right to hearing.
(2) The parties
					 stipulate to the material facts or agree to submit direct and rebuttal
					 testimony or documentary evidence in affidavit form (sworn or affirmed on
					 personal knowledge) or by deposition.
(3) The Bureau determines that there are no
					 material facts in dispute.
(4)
					 Subsections (a)-(c) supersede 1 Pa. Code §
											35.101 (relating to waiver of
					 hearing).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › WAIVER AND EXPEDITED DISPOSITION › Section 41.92 - Expedited disposition procedure for certain appeals

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This section applies to provider appeals
					 involving the denial of claims for payment through the prior authorization
					 process, the denial of requests for precertification, the recovery of
					 overpayments or improper payments through the utilization review process, the
					 denial of claims upon prepayment review, the denial of claims for payment under
					 §
											1101.68 (relating to invoicing for
					 services), the denial, termination or suspension of an exceptional DME grant as
					 defined in §
											1187.2 (relating to definitions)
					 and the denial of a program exception request filed under § 1150.63
					 (relating to waivers).
(b) A
					 request for hearing in a provider appeal subject to this section shall be
					 submitted in writing to the Bureau within the time limits specified in
					 accordance with §
											41.32(a)
					 (relating to timeliness and perfection of requests for hearing) and include
					 both of the following:
(1) The information
					 specified in §
												41.31(d)
					 (relating to request for hearing).
(2) Relevant supporting
					 documentation.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › PREHEARING PROCEDURES AND PREHEARING CONFERENCES › Section 41.101 - Prehearing procedure in certain provider appeals

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Upon the filing of a request for hearing,
					 the Bureau will issue a prehearing order specifying the following:
(1) The parties shall make disclosures in
					 accordance with §§ 41.111-41.117.
(2) Discovery requests must be served within
					 90 days of the date of the prehearing order and discovery must be concluded
					 within 120 days of the date of the prehearing order.
(3) Motions to compel discovery shall be
					 filed within 30 days of the close of discovery.
(4) Other miscellaneous prehearing motions,
					 including motions in limine, shall be filed within 60 days of the date of
					 filing of the program office's position paper.
(5) Dispositive motions shall be filed within
					 60 days of the date of the filing of the program office's position
					 paper.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › PREHEARING PROCEDURES AND PREHEARING CONFERENCES › Section 41.102 - Conferences

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Bureau, on
					 its own motion or on motion of a party, may hold a conference either prior to
					 or during a hearing for the purpose of facilitating settlement, adjustment of
					 the proceeding or another issue therein, or other matters to expedite the
					 orderly conduct and disposition of a hearing.
(b) A stipulation of the parties or order of
					 the Bureau as a result of the conference shall be binding upon the
					 parties.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.111 - Disclosures

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A party to a
					 provider appeal commenced by a request for hearing shall, without awaiting a
					 discovery request, disclose information to each other party as specified in
					 this section.
(b) The program
					 office will disclose the following:
(1) The
					 name, title, business address and telephone number of each staff person
					 directly involved in the agency action, and, if different, the name, title,
					 business address and telephone number of the officials or staff designated to
					 testify on its behalf regarding the agency action and the issues on which the
					 designated individual will testify. In the case of an audit appeal, the program
					 office will, at a minimum, identify every auditor involved in the audit and
					 every audit supervisor and audit manager who reviewed the audit
					 report.
(2) A copy of, or a
					 description by category and location of, the documents, data compilations and
					 tangible things, not privileged or protected from disclosure, that were relied
					 upon in issuing the agency action, or that formed the basis for the agency
					 action.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.112 - Filing of position paper

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 The provider shall file its position paper and required documentation with the
					 Bureau and serve it on the program office within 60 days of the close of
					 discovery or another date as may be specified in the Bureau's prehearing order.
					 If the provider fails to meet the position paper due date or fails to supply
					 the Bureau with the required documentation, the Bureau will dismiss the
					 provider's appeal, unless the provider shows good cause for its
					 noncompliance.
(b) The program
					 office will file its position paper and required documentation with the Bureau
					 and serve it on the provider within 60 days of the date of service of the
					 provider's position paper or another date as may be specified in the Bureau's
					 prehearing order. If the program office fails to meet the position paper due
					 date, the Bureau will bar it from presenting evidence and witnesses at the
					 hearing, unless the program office shows good cause for its
					 noncompliance.
(c) The Bureau
					 disfavors requests for extensions of time to file position papers. The Bureau
					 may grant an extension if the following conditions are met:
(1) A party submits a written request for
					 extension.
(2) The request is
					 received by the Bureau in time for it to review the matter prior to the due
					 date.
(3) The party establishes
					 that good cause exists to warrant an extension.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.113 - Content of provider position paper

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For each issue identified in its request
					 for hearing or amended request for hearing, the provider's position paper must
					 state the relevant facts and present arguments setting forth the provider
					 position.
(b) For each issue
					 identified in its request for hearing or amended request for hearing, the
					 provider shall include the following:
(1) A
					 summary of the pertinent facts and circumstances.
(2) Citations to the relevant statutory
					 provisions, regulations and other controlling authorities.
(3) The monetary amount in dispute only if
					 the sum is certain in whole or in part as of the date the position paper is
					 due. If the sum in dispute is not certain as of the date the position paper is
					 due, the party is required to identify the regulation that is applicable to
					 determining such sum and a supporting affidavit for the reason the sum could
					 not be determined.
(4) An
					 explanation showing how the monetary amount was computed.
(5) Other relief sought by the provider in
					 connection with the issue.
(6) The
					 name and business address of every witness whose testimony the provider will
					 present.
(7) A copy of every
					 document that the provider will offer into evidence to support its position
					 with respect to the issue.
(8) This
					 section supersedes 1 Pa. Code §§
												35.164 and
					 35.165 (relating to documents on
					 file with agency; and public documents).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.114 - Content of program office position paper

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For each issue identified in the
					 provider's position paper, the program office's position paper will state
					 whether it accepts or disputes the provider's statements regarding the
					 following:
(1) Summary of the pertinent facts
					 and circumstances.
(2) Citations to
					 the relevant statutory provisions, regulations and other controlling
					 authorities.
(3) Computation of the
					 monetary amount in dispute.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.115 - Statement regarding expert opinions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For each issue in dispute, a party's
					 position paper must address the party's reliance upon an expert. The party
					 shall state whether its position depends, in whole or in part, upon the
					 judgment, opinion or testimony of a person who, if called to testify, would be
					 called as an expert.
(b) When a
					 party's position depends, at least in part, upon the judgment, opinion or
					 testimony of an expert, the party's position paper must include a "statement of
					 expert opinion."
(c) Consistent
					 with Pa.R.C.P. No. 4003.5 (relating to discovery of expert testimony, trial
					 preparation material), and unless the Bureau orders to the contrary, each
					 expert opinion statement must include the following:
(1) An identification of the expert by name
					 and address.
(2) The subject matter
					 on which the expert is expected to testify.
(3) An identification of the substance of the
					 facts and opinions to which the expert is expected to testify.
(4) A summary of the grounds for each opinion
					 to which the expert is expected to testify.
(5) The signature of the expert.
(6) A brief statement of the expert's
					 qualifications or a current curriculum vitae.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.116 - Amendments to position papers

Current through Register Vol. 54, No. 28, July 13, 2024
The Bureau may permit a party to amend its position paper
						upon motion of the party and for good cause shown.
This section cited in 55 Pa. Code §
													41.25 (relating to amendment or
						  withdrawal of legal documents); 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain appeals); 55 Pa. Code §
													41.101 (relating to prehearing
						  procedure in certain provider appeals); and 55 Pa. Code §
													41.122 (relating to supplementing
						  disclosures and responses).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.117 - Penalties for noncompliance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 party will not be permitted to offer the testimony of a witness at a hearing on
					 a provider appeal unless either the party disclosed the identity of the witness
					 in the party's position paper or the party establishes that there is good cause
					 to permit the testimony of the witness.
(b) A party will not be permitted to
					 introduce a document into evidence at a hearing on a provider appeal unless the
					 party identified the document as an exhibit and served the other parties to the
					 provider appeal with a copy of the document at the time the party filed its
					 position paper with the Bureau unless there is good cause.
(c) This section does not preclude a party
					 from introducing a document or testimony solely for use as an impeachment of a
					 witnesses's credibility even if a party did not give advance notice to the
					 opposing party.
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain appeals); 55 Pa. Code §
													41.101 (relating to prehearing
						  procedure in certain provider appeals); and 55 Pa. Code §
													41.122 (relating to supplementing
						  disclosures and responses).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.118 - Authorized forms of discovery

Current through Register Vol. 54, No. 28, July 13, 2024
Once the time period for mandatory disclosures has
						elapsed, a party to a provider appeal commenced by a request for hearing may
						obtain discovery by one or more of the following methods:
(1) Interrogatories.
(2) Requests for the production of
					 documents.
(3) Expert
					 reports.
(4) Requests for
					 admission.
(5) Depositions of
					 witnesses and designees of parties.
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain appeals); 55 Pa. Code §
													41.111 (relating to disclosures);
						  and 55 Pa. Code §
													41.134 (relating to discovery
						  motions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.119 - General scope of discovery

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Parties may obtain discovery regarding a matter, not privileged, that is
					 relevant to the claim or defense of another party in a provider appeal,
					 including the existence, description, nature, custody, condition and location
					 of the books, documents or other tangible things and the identity and location
					 of persons having knowledge of a discoverable matter.
(b) Except to the extent inconsistent with or
					 as otherwise provided in this chapter, discovery shall be governed by Pa.R.C.P
					 4001-4020 as authorized by this chapter. The term "court" as used in the
					 Pa.R.C.P. means "Bureau"; the term "prothonotary" or "clerk of court" as used
					 in the Pa.R.C.P. means "Formal Docketing Unit."
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain appeals); 55 Pa. Code §
													41.111 (relating to disclosures);
						  and 55 Pa. Code §
													41.134 (relating to discovery
						  motions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.120 - Limitations on scope of discovery

Current through Register Vol. 54, No. 28, July 13, 2024
(a) In addition to the general limitation on
					 the scope of discovery and deposition in Pa.R.C.P. No. 4011 (relating to
					 limitation of scope of discovery and deposition), the following limitations on
					 discovery apply:
(1) Interrogatories to a
					 party, as a matter of right, may not exceed ten in number. Interrogatories
					 inquiring as to the names and locations of witnesses, or the existence,
					 location and custodian of documents or physical evidence each will be construed
					 as one interrogatory.
(i) Other
					 interrogatories, including subdivisions of one numbered interrogatory, will be
					 construed as separate interrogatories.
(ii) If counsel for a party believes that
					 more than ten interrogatories are necessary, counsel shall consult with
					 opposing counsel promptly and attempt to reach a written stipulation as to a
					 reasonable number of additional interrogatories.
(iii) Counsel are expected to comply with
					 this requirement in good faith. If the parties cannot agree on a written
					 stipulation, the Bureau, upon motion of a party, may permit the party to serve
					 additional interrogatories if the party establishes to the Bureau's
					 satisfaction that additional interrogatories are reasonable and necessary in
					 light of the particular facts involved and that they will not prevent the
					 prompt and efficient adjudication of the provider appeal.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.121 - Timing and sequence of discovery

Current through Register Vol. 54, No. 28, July 13, 2024
Unless the Bureau upon motion, for the convenience of
						parties and witnesses and in the interest of justice, orders otherwise, methods
						of discovery may be used regardless of sequence, and the fact that a party is
						conducting discovery, whether by deposition or otherwise, does not operate to
						delay another party's discovery.
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain appeals); 55 Pa. Code §
													41.111 (relating to disclosures);
						  and 55 Pa. Code §
													41.134 (relating to discovery
						  motions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.122 - Supplementing disclosures and responses

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A party has a duty to supplement or
					 correct a disclosure under §§
											41.111-41.117 to include information
					 thereafter acquired if ordered by the Bureau or if the party learns that in
					 some material respect the information disclosed is incomplete or incorrect and
					 if the additional or corrective information has not otherwise been made known
					 to the other parties during the discovery process or in writing.
(b) A party is under a duty to supplement
					 responses made to discovery requests as set forth in Pa.R.C.P. No. 4007.4
					 (relating to supplementing responses).
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain
						  appeals).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › DISCLOSURES AND DISCOVERY › Section 41.123 - Signing of disclosures, discovery requests, responses and objections

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Every
					 disclosure shall be signed by at least one attorney of record in the attorney's
					 individual name, whose address shall be stated. An unrepresented party shall
					 sign the disclosure and state the party's address. The signature of the
					 attorney or party constitutes a certification that to the best of the signer's
					 knowledge, information, and belief, formed after a reasonable inquiry, the
					 disclosure is complete and correct as of the time it is made.
(b) Every discovery request, response or
					 objection made by a party represented by an attorney shall be signed by at
					 least one attorney of record in the attorney's individual name, whose address
					 shall be stated. An unrepresented party shall sign the request, response, or
					 objection and state the signer's address.
(c) The signature of the attorney or party
					 constitutes a certification that to the best of the signer's knowledge,
					 information and belief, formed after a reasonable inquiry, the request,
					 response or objection is:
(1) Consistent with
					 this chapter and warranted by existing law or a good faith argument for the
					 extension, modification or reversal of existing law.
(2) Not interposed for an improper purpose,
					 such as to harass or to cause unnecessary delay or needless increase in the
					 cost of litigation.
(3) Not
					 unreasonable or unduly burdensome or expensive, given the needs of the case,
					 the discovery already had in the case, the amount in controversy, and the
					 importance of the issues at stake in the litigation.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › MOTIONS › Section 41.131 - Motions in general

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This
					 section applies to every motion, except oral motions made during the course of
					 a hearing.
(b) Motions and
					 responses to motions must be in writing, signed by a party or its attorney and
					 accompanied by a proposed order.
(c) Unless the time is extended by the
					 Bureau, a response to a dispositive motion shall be filed within 30 days of
					 service of the motion, and a response to other motions shall be filed within 20
					 days of service of the other motions.
(d) Except in the case of a dispositive
					 motion, the Bureau will deem a party's failure to respond to a motion to be the
					 party's lack of opposition to the motion.
(e) Except in the case of a dispositive
					 motion, the moving party may not file a reply to a response to its motion,
					 unless the Bureau orders otherwise.
(f) Subsections (a)-(e) supersede 1 Pa. Code
					 §§
											35.54,
					 35.55 and
					 35.179 (relating to motions as to
					 complaint; motions as to answer; and objections to motions).
This section cited in 55 Pa. Code 41.81 (relating to
						  consolidation of provider appeals).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › MOTIONS › Section 41.132 - Actions on motions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 Bureau will rule on dispositive motions within 60 days after the moving party's
					 reply to the nonmoving party's response, if a reply is filed. If the moving
					 party does not file a reply, the Bureau will rule on a dispositive motion
					 within 60 days after the date on which the nonmoving party's response is
					 due.
(b) The Bureau will rule on
					 motions other than dispositive motions within 30 days after the date on which
					 the nonmoving party's response is due.
(c) Notwithstanding subsections (a) and (b),
					 the Bureau will rule on each outstanding prehearing motion no later than 20
					 days prior to the commencement of the hearing.
(d) Subsections (a)-(c) supersede 1 Pa. Code
					 §
											35.180(a)
					 (relating to action on motions).
This section cited in 55 Pa. Code §
													41.81 (relating to consolidation
						  of provider appeals).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › MOTIONS › Section 41.133 - Procedural motions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This
					 section applies to motions that pertain to the procedural aspects of a case,
					 including motions for continuance, expedited consideration, extensions of time
					 in which to file documents and stays of proceedings.
(b) Procedural motions must contain a
					 statement indicating the nonmoving party's position on the relief requested or
					 a statement that the moving party, after a reasonable effort, has been unable
					 to determine the nonmoving party's position.
(c) If the parties consent to the relief
					 requested, the request may be embodied in a letter, provided the letter
					 indicates the consent of the other parties.
(d) Requests for extensions or continuances,
					 whether in letter or motion form, must be accompanied by a proposed
					 order.
(e) Procedural motions and
					 responses may not be accompanied by supporting memoranda of law unless
					 otherwise ordered by the Bureau.
This section cited in 55 Pa. Code §
													41.81 (relating to consolidation
						  of provider appeals); and 55 Pa. Code §
													41.136 (relating to miscellaneous
						  motions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › MOTIONS › Section 41.134 - Discovery motions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This
					 section applies to motions filed to resolve disputes arising from the conduct
					 of discovery under §§ 41.118-41.121.
(b) A motion to compel discovery must contain
					 as exhibits the discovery requests and answers giving rise to the
					 dispute.
(c) A party may file a
					 memorandum of law in support of its discovery motion or its response to a
					 discovery motion. The supporting memorandum of law shall be filed at the same
					 time the motion or response is filed.
This section cited in 55 Pa. Code §
													41.81 (relating to consolidation
						  of provider appeals); 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain appeals); and 55 Pa. Code §
													41.136 (relating to miscellaneous
						  motions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › MOTIONS › Section 41.135 - Dispositive motions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This
					 section applies to dispositive motions.
(b) Motions for summary judgment or partial
					 summary judgment and responses to those motions must conform to Pa.R.C.P. No.
					 1035.1-1035.5 (relating to motion for summary judgment).
(c) Dispositive motions must be accompanied
					 by a supporting memorandum of law. The Bureau may deny a dispositive motion if
					 a party fails to file a supporting memorandum of law.
(d) An affidavit or other document relied
					 upon in support of a dispositive motion, response or reply, that is not already
					 a part of the record, must be attached to the motion, response or reply or it
					 will not be considered by the Bureau in ruling thereon.
This section cited in 55 Pa. Code §
													41.81 (relating to consolidation
						  of provider appeals); 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain appeals); 55 Pa. Code §
													41.136 (relating to miscellaneous
						  motions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › MOTIONS › Section 41.136 - Miscellaneous motions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This
					 section applies to a motion not otherwise addressed in §§
											41.133-41.135 (relating to procedural
					 motions; discovery motions; and dispositive motions), including a motion in
					 limine, a motion to strike and a motion for recusal.
(b) A memorandum of law in support of a
					 miscellaneous motion or response to a miscellaneous motion shall be filed with
					 the miscellaneous motion or response.
This section cited in 55 Pa. Code §
													41.81 (relating to consolidation
						  of provider appeals); and 55 Pa. Code §
													41.136 (relating to miscellaneous
						  motions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › MEDIATION › Section 41.141 - Voluntary mediation

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Upon
					 request by the parties, the Bureau may stay a provider appeal commenced by a
					 request for hearing for up to 120 days to allow the parties to utilize
					 voluntary mediation services through the Office of General Counsel Mediation
					 Program.
(b) The parties shall file
					 their request for stay with the Bureau at least 14 days before initiation of
					 hearings by the Bureau.
(c) At the
					 end of the initial stay, the parties shall jointly file a statement that sets
					 forth the status of mediation activities conducted. The parties may request an
					 additional stay if necessary to complete the mediation process.
(d) The grant of an additional stay for
					 mediation is in the Bureau's discretion and the Bureau may impose limitations
					 the Bureau deems appropriate.
(e) A
					 party's participation in voluntary mediation may not be used as evidence in a
					 proceeding before the Bureau.
(f)
					 Communications between the parties during the mediation period shall be
					 regarded as offers of settlement and are neither discoverable nor admissible as
					 evidence in a proceeding before the Bureau.
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition for certain appeals).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › HEARINGS › Section 41.151 - Initiation of hearings

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If,
					 after the Bureau has ruled on a dispositive motion, a hearing is required to
					 determine the remaining issues, the Bureau will, after consultation with the
					 parties, schedule a formal evidentiary hearing and send a notice of hearing to
					 each of the parties to the provider appeal.
(b) A hearing may, if permitted by this
					 chapter or by agreement of the parties, be conducted via telephone.
(c) Subsections (a) and (b) supersede 1 Pa.
					 Code §
											35.121 (relating to initiation of
					 hearings).
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain
						  appeals).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › HEARINGS › Section 41.152 - Continuance of hearings

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 hearing may not be continued except for compelling reasons.
(b) A motion for continuance of a hearing
					 must be submitted to the Bureau in writing with a copy served upon the other
					 parties to the proceedings, except that during the course of a hearing in a
					 proceeding, the requests may be made by oral motion in the hearing.
(c) In the event that the parties are engaged
					 in good faith settlement negotiations, the Bureau may grant a joint continuance
					 request of not more than 60 days.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › HEARINGS › Section 41.153 - Burden of proof and production

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Except as provided in subsection (b), the provider has the burden of proof to
					 establish its case by a preponderance of the evidence and is required to make a
					 prima facie case by the close of its case-in-chief.
(b) If the agency action at issue in the
					 provider's appeal is based upon the Department's determination that the
					 provider committed an act prohibited by section 1407(a)(1) of the Public
					 Welfare Code (62 P. S. §
												1407(a)(1)), or §
											1101.75(a)(1) or (2)
					  (relating to provider prohibited acts), the
					 Department has the burden of proving that the provider violated those
					 provisions. The provider has the burden of proving the other issues raised in
					 the provider's request for hearing.
(c) The party with the burden of proof has
					 the burden of production, unless otherwise directed by the presiding officer,
					 upon a determination included in the record by the presiding officer that the
					 evidence is peculiarly within the knowledge or control of another party or
					 participant, in which case the order of presentation may be varied by the
					 presiding officer.
(d) Each party
					 shall have the right to an opening statement, presentation of evidence,
					 cross-examination, objection, motion and argument and closing
					 argument.
(e) A pleading or a
					 position paper must, without further action, be considered part of the record.
					 A pleading or a position paper will never be considered as evidence of a fact
					 other than that of the filing thereof, unless offered and received into
					 evidence under this chapter.
(f)
					 Subsections (a)-(e) supersede 1 Pa. Code §§
											35.125 and
					 35.126 (relating to order of
					 procedure; and presentation by the parties).
This section cited in 55 Pa. Code §
													41.114 (relating to content of
						  program office position paper).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › EVIDENCE AND WITNESSES › Section 41.161 - Written testimony

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Written testimony of a witness, including an expert witness, on numbered lines
					 in question and answer form, may be admitted into evidence provided the witness
					 is present for cross-examination at the hearing or the parties agree that the
					 witness' presence at the hearing is not required.
(b) Written testimony shall be filed
					 concurrently with the proffering party's position paper unless a different time
					 is prescribed by the Bureau. Objections to written testimony that can be
					 reasonably anticipated prior to hearing must be in writing and filed within the
					 time prescribed for prehearing motions in limine, unless otherwise ordered by
					 the Bureau.
(c) If a party desires
					 to file written testimony prior to the close of the record, it may do so only
					 upon motion approved by the Bureau for good cause. This approval will include
					 the scope of the written testimony and the time for filing the testimony and
					 service upon opposing counsel.
(d)
					 Subsections (a)-(c) supersede 1 Pa. Code §§
											35.138 and
					 35.139 (relating to expert
					 witnesses; and fees of witnesses).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › EVIDENCE AND WITNESSES › Section 41.162 - Subpoenas

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Except as
					 otherwise provided in this chapter or by order of the Bureau, requests for
					 subpoenas and subpoenas will be governed by Pa.R.C.P. No. 234.1-234.4 and
					 234.6-234.9. The term "court" as used in Pa.R.C.P means "Bureau"; the term
					 "Prothonotary" or "clerk of court" as used in Pa.R.C.P means "Formal Docketing
					 Unit."
(b) Proof of service of the
					 subpoena need not be filed with the Bureau.
(c) Subsections (a) and (b) supersede 1 Pa.
					 Code §
											35.142 (relating to
					 subpoenas).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › PRESIDING OFFICERS › Section 41.171 - Independence

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The presiding
					 officers will act independently of employees or public officials of the
					 Department whose actions are subject to review before the Bureau.
(b) The presiding officers may not engage in
					 ex parte communications concerning a hearing with a party to the
					 hearing.
(c) A presiding officer
					 may withdraw from a proceeding when he deems himself disqualified, or he may be
					 withdrawn by the agency head for good cause found after timely affidavits
					 alleging personal bias or other disqualification have been filed and the matter
					 has been heard by the agency head or by another presiding officer to whom the
					 agency head has delegated the matter for investigation and report.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › POSTHEARING PROCEDURES › Section 41.181 - Posthearing briefs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 initial posthearing brief of each party must be as concise as possible and may
					 not exceed 50 pages. An initial posthearing brief must contain proposed
					 findings of fact, with references to the appropriate exhibit or page of the
					 transcript, an argument with citation to supporting legal authority and
					 proposed conclusions of law.
(b)
					 The provider shall file its initial posthearing brief first and within the time
					 specified by the presiding officer, which may not be less than 30 days from the
					 closing of the record unless the provider consents to a shorter period of time.
					 The program office will file its initial posthearing brief within 30 days of
					 the date of service of the provider's brief.
(c) The provider may file a reply brief
					 within 20 days of service of the program office posthearing brief. A reply
					 brief must be as concise as possible and may not exceed 25 pages.
(d) Longer briefs and surreply briefs may be
					 permitted at the discretion of the presiding officer.
(e) A party may waive the filing of a
					 posthearing brief.
(f) If a party
					 files a posthearing brief, a disputed issue or legal theory that is not argued
					 in the party's posthearing brief will be deemed waived.
(g) Subsections (a)-(f) supersede 1 Pa. Code
					 §§
											35.191-35.193 (relating to proceedings in
					 which briefs are to be filed; content and form of briefs; and filing and
					 service of briefs).
This section cited in 55 Pa. Code §
													41.92 (relating to expedited
						  disposition procedure for certain
						  appeals).