Md. Code Regs. 10.01.04.02 : MARYLAND DEPARTMENT OF HEALTH —Part 1 — PROCEDURES — Fair Hearing Appeals Under the Maryland State Medical Assistance Program — Opportunity for a Fair Hearing

A. An opportunity for a fair hearing shall be granted if:
(1) A Program applicant claims their application for Program eligibility is denied;
(2) A Program applicant claims that the determination of eligibility received through Maryland Health Connection is incorrect;
(3) A Program applicant claims their application for eligibility, or any part thereof, is not acted upon within:
(a) 30 days from the date of application to an insurance affordability program;
(b) 45 days from the date of application for aged or blind applicants to the Program; or
(c) 60 days from the date of application to the Program in the case of determination of disability;
(4) A Program recipient asserts their claim for Program services has been erroneously denied or is not acted upon with reasonable promptness;
(5) A Program recipient asserts that the Program has acted erroneously;
(6) A Program recipient residing in a skilled nursing facility or nursing home asserts that the recipient has been or will be erroneously transferred or discharged;
(7) A Program recipient asserts that the Program has made an erroneous decision related to nursing home preadmission and annual review; or
(8) A Program participant in an MCO is appealing an action by an MCO and the appeal has been filed within 120 days from the date specified in the notice from the MCO as required by COMAR 10.09.71.05.
B. The administrative law judge may not grant a fair hearing if the sole issue is a federal or State law requiring an automatic change adversely affecting some or all Program recipients.

Md. Code Regs. 10.01.04.02

Regulation .02A amended effective April 15, 2013 (40:7 Md. R. 610); amended effective 45:21 Md. R. 973, eff. 10/8/2018; amended effective 45:21 Md. R. 973, eff. 10/22/2018; amended effective 46:10 Md. R. 485, eff. 5/20/2019