Ala. Admin. Code r. 560-X-3-.07

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-3-.07 - Denial Of A Hearing

(1) If the request tor a hearing, in the opinion of Medicaid legal counsel, presents only a legal issue, and the validity of the controlling law or regulation is not challenged in the hearing request, a fair hearing request may be denied.

(2) If eligibility of a provider or a recipient has been terminated because of a criminal conviction for Medicaid fraud or abuse, or if a provider has been terminated because of loss of required licensure, then no fair hearing need be given. A certified copy of the judgement of conviction or of the decision to revoke or suspend a provider's license shall be conclusive proof of ineligibility for further participation in the Medicaid Program. The pendency of an appeal for any such conviction or license revocation or suspension shall not abate the termination of Medicaid eligibility. If a conviction, or license revocation or suspension is reversed on appeal, the recipient or provider may apply for reinstatement to the Medicaid program. However, the reasons for the reversal will be scrutinized by Medicaid and reinstatement will be at the sole discretion of the Commissioner.

Author:

Ala. Admin. Code r. 560-X-3-.07

Rule effective October 1, 1982.

Statutory Authority: State Plan, Title XIX, Social Security Act; 42 C.F.R. §§ 401, etseq.