Mail 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 Hearing
An 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
Requests
If 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 Action
The 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.
