Ga. Comp. R. & Regs. R. 350-4-.02 - Hearings Conducted by the Department of Human Resources
(1) Hearings shall be conducted by the Department of Human
Resources in the following cases:
(a) when a recipient of medical assistance is aggrieved by the
action or inaction of the Department as to any medical or remedial care or
service which such recipient alleges should be reimbursed under the terms of
the Georgia State Plan for Medical Assistance which was in effect on the date
on which such care or service was rendered or is sought to be rendered;
(b) when an application for medical assistance is denied or is
not acted upon with reasonable promptness;
(c) when a recipient or applicant has been aggrieved by an
action or inaction of the Department or its agent with respect to a
determination of the level of care status applicable to that person;
(d) when individuals are adversely affected by determinations
made during the pre-admission screening or post-admission resident review
required by Social Security Act °1919(e)(7), as amended, as implemented by
Section 4211 of the Omnibus Budget Reconciliation Act of 1987;
(e) when an institution has received notice that it will
be:
1. decertified to participate under the State Plan for Medical
Assistance,
2. denied a license to operate a nursing facility, or
3. refused enrollment as a provider in the State Plan or
terminated as a provider based on the want of any license, permit, certificate,
approval, registration, charter or other form of permission issued by the
Department of Human Resources;
(f) when a hearing is obtained pursuant to the provisions of
Chapter 350-3 of these Rules; and
(g) when a recipient or applicant has been aggrieved by an
action of the Department or its agent with respect to collection of funds paid
in behalf of the recipient for medical services.
(2) All hearings pursuant to this section will be conducted
under the Rules of the Department of Human Resources.
Notes
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