Mont. Admin. R. 37.5.318 - ADMINISTRATIVE REVIEW
(1) Upon the
request for a hearing by a claimant or a provider, other than a medical
assistance provider, the department shall conduct an administrative review with
the purpose of resolving the case and avoiding an unnecessary hearing. This
review may be conducted in person or by telephone. In person reviews shall be
conducted at a place designated by the reviewer and reasonably convenient to
the claimant or as designated by the hearing officer.
(a) No administrative review is required by
this rule:
(i) if the department provides by
other rule for an administrative review or other substantially equivalent
process prior to a hearing request. If the department provides by rule for such
a process, a hearing may not be granted unless the claimant or provider has
exhausted the process in a timely manner; or
(ii) in any of the following matters:
(A) hearings pursuant to ARM
37.5.105 contesting a transfer or
discharge of a nursing facility resident by a nursing facility;
(B) hearings pursuant to the Youth Access to
Tobacco Act, Title 16, chapter 11, part 3, MCA;
(C) as otherwise provided by department
rule.
(2) An administrative review includes:
(a) an informal conference with the
department, subject to (3); and
(b)
a review of relevant facts, legal authority and circumstances involved in the
adverse action by the department and the preparation of an administrative
review report for submission to the hearing officer within 20 days from the
date the request for administrative review is mailed from the hearing officer
to the person responsible for conducting the review, or within such other
longer period specified by the hearing officer or agreed upon by the
parties.
(3) The
department official designated to conduct the administrative review may
schedule the administrative review conference and must notify the claimant or
provider of the date, time and place of the conference. If the claimant or
provider cannot appear at the date and time set for the conference, the
claimant or provider shall be given a reasonable opportunity to reschedule the
conference. An additional opportunity or opportunities to reschedule may be
granted for good cause shown.
(a) The
conference shall be conducted at the office of the department official
designated to conduct the administrative review, or may be conducted
telephonically.
(b) The
notification of the date, time, and place may inform the claimant or provider
that if the claimant or provider fails to appear at the date, time, and place
scheduled or fails to cooperate reasonably in scheduling and completing the
conference, the conference will not be rescheduled and the administrative
review report will be completed without a conference.
(c) The official designated to conduct the
administrative review may proceed to conduct and complete the administrative
review report without a conference if:
(i)
the notification permitted by (3)(b) has been provided and the claimant or
provider does not appear at the conference at the time scheduled and the
conference has not been rescheduled; or
(ii) the claimant or provider does not
cooperate reasonably in scheduling and completing the conference.
(4) An adverse action
may be reversed or modified by the department or its designee at any time
before, during or after the administrative review, in which case a hearing will
not be held unless the claimant or provider is aggrieved by the modified
adverse action and requests that the hearing be held.
(a) If the adverse action is modified or
reversed by the department and the benefits which are the subject of the
adverse action include county funds, a county human services or welfare office
may request the hearing officer to hold the hearing if it is aggrieved by the
action of the division administrator.
Notes
53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA; IMP, 53-2-201, MCA;
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