Section 511.9 - Fair hearings.

511.9 Fair hearings. (a) The recipient is entitled to a fair hearing when:

(1) an application for an exemption is denied; or

(2) an application for an increase in a utilization threshold is denied and a recipient has reached the utilization threshold.

(b) (1) The fair hearing pursuant to this section will be limited to the issues set forth in the application for the increase or exemption, and the reasons for denial contained in the written determination. The hearing request and the procedures for the conduct of the hearing are governed by Part 358 of this Title.

(2) Notwithstanding the provisions of paragraph (1) of this subdivision, the recipient may raise at the fair hearing requested pursuant to this section the issue of whether the number of service units attributed to the recipient for a provider service type accurately reflects the recipient's use of such service type.

(3) The MA program will not pay for medical care, services, or supplies in excess of a utilization threshold pending the outcome of a fair hearing pursuant to this section, except as provided in Section 511.7 of this Part.

 

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