ADMINISTRATIVE REVIEW, HEARINGS AND APPEALS

(1) An Administrative Law Judge appointed by the Department shall conduct provider hearings with respect to the following cases: (a) when a provider is aggrieved by an action of the Department with respect to a denial of, or the determination of the amount of, medical assistance …

(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 re…

(1) Providers may represent themselves, or may choose to be represented by legal counsel or any other spokesperson. However, providers may not be represented by employees or agents of the Department. (2) An Administrative Law Judge may exclude from the hearing any person who: (a)…

The Department shall offer the opportunity for Administrative Review to any provider against whom it proposes to take an adverse action unless the Department is otherwise authorized by law to take such action without opportunity for appeal by the provider prior to the action's im…

(1) A request for a hearing must be in writing and received by the Department: (a) within ten (10) days after the date on which a notice of denial of a request for enrollment or notice of suspension or termination was transmitted to the provider; or (b) concerning any other actio…

The Administrative Law Judge may dismiss a request for a hearing for the following reasons: (a) it has been withdrawn by the provider in writing; (b) there is no genuine issue of law or fact which requires a hearing determination; (c) the provider without good cause therefor fail…

(1) Informal disposition may be made of any contested case by stipulation, written agreement, or consent order. (2) The parties may agree to settle the matters in dispute at any time prior to the issuance of the Administrative Law Judge's decision, whereupon the Administrative La…

(1) Each request for hearing meeting the specifications of Section 350-4-.06 shall be transmitted to an Administrative Law Judge appointed under authority of the Commissioner to adjudicate the matter in dispute. (2) The Administrative Law Judge shall be a competent, qualified, an…

(1) An Administrative Law Judge shall voluntarily withdraw from any proceedings in which he cannot render a fair and impartial decision for any reason. (2) A party may request the disqualification of an Administrative Law Judge by filing a written request or motion therefor accom…

Commencing with the appointment of an Administrative Law Judge, no person shall communicate ex parte with such Administrative Law Judge relating to the merits of the proceeding until after the issuance of a final decision unless all parties involved in the proceedings are informe…

As soon as practicable after being appointed to hear a case, the Administrative Law Judge shall issue a notice of hearing, stating the time and place of the hearing, the legal authority and jurisdiction pursuant to which the hearing was requested, the issues to be addressed, and …

(1) The Administrative Law Judge may, either sua sponte or at the request of any party, direct the parties or their authorized representatives to appear at a specified time and place for one or more conferences before or during a hearing or to submit written proposals or correspo…

(1) The hearing shall be conducted at the offices of the Department of Medical Assistance unless exigent circumstances necessitate a different venue, and at a reasonable time and date. Reasonable notice of the time and location shall be given to all parties prior to the scheduled…

(1) The Administrative Law Judge may continue and/or reopen a hearing: (a) on the Administrative Law Judge's own motion, (b) at the request of any party, only upon a showing of good cause, or (c) upon agreement by the parties. (2) Notice of the time and place of a continued or re…

(1) If a party fails to appear at a hearing after receiving notice thereof, the Administrative Law Judge shall proceed with the hearing in the absence of the party or dismiss the action on motion of any party or sua sponte. (2) If the party requesting a hearing fails to take acti…

(1) Discovery is limited to the following. (a) A party, upon written request made to another party within a reasonable time prior to the hearing, is entitled to: 1. obtain the names, addresses, and telephone numbers of the witnesses which the other party intends to call to testif…

(1) The Administrative Law Judge shall have the authority to issue subpoenas requiring the attendance and testimony of witnesses and the production of objects or documents at depositions or hearing. (2) Every subpoena shall be prepared by the requesting party and issued by the Ad…

(1) At any time during the course of a proceeding, the Administrative Law Judge may, in his discretion, order that the testimony of a witness be taken by deposition. Application to take a deposition in lieu of personal appearance at the hearing shall be made by motion. Such motio…

(1) The notice of adverse action issued by the Department and the request for hearing submitted by the provider shall constitute the pleadings in each contested case and automatically shall be included in the Record. The pleadings shall be transmitted by the Department to the Adm…

(1) Relevant allegations of fact contained in the Pleadings and automatic filings shall be deemed admitted unless specifically contested. (2) Irrelevant, immaterial, or unduly repetitious evidence shall be excluded. The rules of evidence as applied in the trial of civil, nonjury …

(1) The Administrative Law Judge may, upon motion and in the exercise of discretion, permit such substitution of parties as justice requires, provided that the original party and the party to be substituted otherwise qualify individually as parties to the proceedings under all ap…

(1) When two or more providers appeal matters involving common issues of law or fact, the appeals may be consolidated by the Department or by the appointed Administrative Law Judge(s) and heard together if it appears that a joint hearing would serve to expedite or simplify consid…

(1) The party filing any submission shall simultaneously serve a copy of each submission upon each party of record. Service shall be by mail or personal delivery. Service by mail shall be complete upon mailing by first class mail, with proper postage attached, to a party's addres…

(1) The hearing shall be opened with reasonable promptness as fixed in the "notice of hearing." (2) All Department hearings shall be accessible to the public, subject to requirements for safeguarding confidential information. (3) In all hearings, taking of testimony shall be unde…

(1) An application to the Administrative Law Judge for an order requiring any party to take any action or entering any interlocutory ruling shall be made by motion. Unless made during the hearing, motions shall be in writing, shall state specifically the grounds therefor, and sha…

(1) Any party may move, if supported by affidavits or other probative evidence, for a summary determination in its favor upon any of the issues being adjudicated on the basis that there is no genuine issue of material fact for determination. Such a motion must be filed and served…

(1) The Administrative Law Judge shall compile an official Record of the hearing, which shall include: (a) all pleadings, automatic filings, motions, and intermediate rulings; (b) a transcript of the oral testimony received in evidence; (c) all documents received in evidence; (d)…

(1) The decision of the Administrative Law Judge shall be based exclusively on competent evidence and other material introduced pursuant to this Chapter. It shall specify the reason for the decision and identify the supporting evidence and regulations, and include findings of fac…

(1) Any provider may petition for review of the Administrative Law Judge's decision within five (5) days from the date of that party's receipt of the decision. Such request shall be in writing and addressed to the Commissioner and shall state the legal or factual errors upon whic…

(1) Any provider adversely affected by a final decision of the Commissioner may have review thereof by appeal to the superior court in the county of residence of the provider or to the Superior Court of Fulton County. Such appeal shall be by petition which shall be filed in the c…