Page 6

COMAR 10.09.24.13

1305 State of Maryland Medical Assistance Manual Revised July 2012 2. The Medical Assistance Compliance Administration shall institute procedures to recover the cost of any expenditures made on behalf of a recipient in cases identified in §C (1) of this regulation. This provision may not apply to a person who requested a hearing and extended benefits resulting from a bona fide belief that the LDSS has taken an adverse action erroneously.

A significant feature of the hearing regulation involves the recovery of expenditures made on belief of ineligible persons, who appealed without a bona fide belief that the LDSS was wrong in its decision. An ineligible recipient may be granted a continuation of coverage solely because he/she appeals the decision of ineligibility; if the hearing officer affirm the decision of ineligibility, the program will seek reimbursement from the recipient for any expenditures made on his/her behalf during the period for which he/she was covered solely because he/she appealed, unless he/she can demonstrate that this appeal was based on a bona fide belief that the LDSS was acting in error in declaring him/her ineligible . The local department will be responsible for advising the recipient of the possible consequences of using the Medical Assistant card, for identifying the case records for future referral, and for completing a referral form for the Medical Assistance Compliance Administration on all such cases in which the hearing officer affirms the local department’s decision. Medical Assistance Compliance Administration will determine the recipient’s intent in appealing and the extent of programs expenditures, and will seek reimbursement if appropriate.

(d) The Conduct of Hearings

The conduct of hearings is governed by the regulations of the Office of Hearings, DHMH. The local departments are involved in the process as conduits for hearing requests and as custodians of the case record. A representative of the LDSS is expected to attend the appeal hearing and present the LDSS’s position on the issues which form the basis for the appeal. The local department should offer a pre-appeal conference to the appellant to ensure that the appellant understands the reason for the local department’s decision; the appellant must be advised that he/she does not give up his/her right to a hearing by participating in such a conferences.

Hearings shall be conducted according to COMAR 10.01.04