Section 144-150-1.10 - NOTICE OF OPPORTUNITY FOR A FAIR HEARINGMail a copy of the hospital's Free Care Policy to:
Rate Setting Unit
Office of Operations and Support
Department of Health and Human Services
11 State House Station,
Augusta, ME 04333-0011
A. In accordance with 22 M.R.S.A. §1716 the Department must grant the opportunity for a fair hearing regarding eligibility for free care to: (1) Any applicant who requests it because his or her claim for free care is denied or not acted upon with reasonable promptness, or(2) Any recipient of care who requests it because he or she believes the hospital has taken an action erroneously.B.Procedure to Request an Administrative HearingAn applicant for free care may request an Administrative hearing if he or she is aggrieved by the action that denies the request for free care. The Department may respond to a series of individual requests for a hearing by conducting a single group hearing. The applicant must follow the procedures described in this Section when requesting an administrative hearing.
(1) An Administrative Hearing may be requested by an applicant or his/her representative.(2) Unless otherwise specified in these rules, administrative hearings must be requested within sixty (60) days of the date of written notification to the applicant of the action the applicant wishes to appeal.(3) Request must be made by the applicant or his/her representative, in writing or verbally, for a Hearing to the Administrative Hearings Unit, Department of Health and Human Services, 11 State House Station, Augusta, Maine 04333-0011. For the purposes of determining when a hearing was requested, the date of the fair hearing request shall be the date on which the request for a hearing is made is considered the date of request for the hearing. The Administrative Hearings Unit may also request that a verbal request for an administrative hearing be followed up in writing, but may not delay or deny a request on the basis that a written follow-up has not been received.(4) The Hearing will be held in conformity with the Maine Administrative Procedure Act, 5 M.R.S.A. §8001et seq. and the Department's Administrative Hearing Manual.(5) The Hearing will be conducted at a time, date and place convenient to hospital and the claimant, and at least twenty (20) days preliminary notice will be given. In scheduling a hearing, there may be instances where the hearing officer shall schedule the hearing location near the claimant or by telephone or Interactive Television System.(6) The Department, the hospital and the applicant may be represented by legal counsel and may have witnesses appear.(7) When a medical assessment by a medical authority other than the one involved in the decision under question is requested by the hearings officer, the hospital or the applicant and considered necessary by the hearings officer, it will be obtained at the Department's expense, and forwarded to the applicant or the applicant's representative, the hospital or its representative, and hearing officer allowing all parties to comment.(8) When the applicant or the hospital or a Department staff person requests a delay, the hearing officer may reschedule the hearing, after notice to all parties.(9) The decisions, rendered by the hearing authority, in the name of the Maine Department of Health and Human Services, will be binding upon the Department, unless the Commissioner directs the hearing officer to make a proposed decision reserving final decision making authorization to him or herself.(10) Any person who is dissatisfied with the hearing authority's decision has a right to judicial review under Maine Rules of Civil Procedure, Rule 80C. C.Dismissal of Administrative Hearing RequestsIf any of the following circumstances exist, the Office of Administrative Hearings may dismiss the request for an administrative hearing.
(1) The claimant withdraws the request for a hearing. (a) The claimant, without good cause, abandons the hearing by failing to appear.(b) The sole issue being appealed is one of federal or state law requiring an automatic change adversely effecting some or all applicants for free care.(2) Where an applicant's request for an administrative hearing is dismissed pursuant to this Section, the Office of Administrative Hearings shall notify the individual of his or her right to appeal that decision in Superior Court.D.Corrective ActionThe hospital must promptly make corrective action when appropriate, retroactive to the date an incorrect action was taken by the hospital if:
(1) The hearing decision is favorable to the applicant; or(2) The agency decides in the applicant's favor before the hearing.10- 144 C.M.R. ch. 150, § 1.10