LD 1356
pg. 2
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LR 1441
Item 1

 
Sec. 2. 22 MRSA §42, sub-§7, as enacted by PL 2001, c. 666, Pt. C,
§1, is amended to read:

 
7. Appeal process. The department shall amend the rules
governing appeals of informal review decisions of Medicaid
MaineCare payment and cost report audit and review issues filed
by MaineCare providers of nursing facility services and medical
and remedial private nonmedical institution services of goods and
services or initiated by the department and any other informal
review decisions that seek to impose repayment, recovery or
recoupment obligations or sanctions or fines on providers as
provided in this subsection.

 
A. The department shall give to the provider involved in an
informal review decision written notice of the appeal
process and the time period for filing a notice of appeal.

 
B. The department shall contract with a person or persons
who are not employees of the department for independent,
impartial hearing officer services.

 
C. Compensation under the any contract into which the
department enters for hearing officer services may reflect
the number of appeals on which recommendations are made by
the hearing officer and may not reflect the substance of the
recommendations made by the hearing officer.

 
D. The hearing officer shall conduct a hearing de novo on
issues raised in the notice of appeal filed by the provider
and shall in a timely manner render a written recommendation
based on the record and in accordance with applicable state
and federal law, rule and regulation. The hearing officer
shall provide a copy of the recommendation to the department
and to the provider along with notice of the opportunity to
submit written comments to the commissioner.

 
E. The recommendation of the hearing officer must be
forwarded to the commissioner for a final decision, based on
the record, which must include any written comment submitted
in a timely manner by the provider and the department. The
commissioner may adopt, adopt with modification or reject
the recommendation of the hearing officer. The commissioner
shall issue a final decision in writing, which must include
the reasons for any departure from the recommendation of the
hearing officer and notice of the process for appeal
pursuant to Title 5, chapter 375, subchapter VII 7. If the
commissioner deviates from a prior decision cited in the
course of a proceeding, the final decision must include an
explanation of the reason that the prior decision was not
followed.


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