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Title: Section 515.6 - Notification.

515.6 Notification. (a) Notice of proposed agency action. (1) If the department proposes to sanction a person or to require restitution or repayment of overpayments under this Part, it must first send the person a written notice of proposed agency action stating the reasons for the proposed action, the legal authority for the action, the nature and amount of any overpayment determined to have been made as a result of the unacceptable practices and the notice also must advise the person of the opportunity to submit documentation or written arguments objecting to the proposed action within 30 days of receipt of the notice. The notice must state that the failure to object within the time provided may result in the adoption of the proposed action as the final agency action and that, pursuant to Section 519.18 of this Title, the issues to be addressed at an administrative hearing will be limited to those matters contained in any objection to the proposed action. The notice must be sent to the person's designated correspondence address, address designated for receipt of payments or last known address.

(2) Any documentation or written arguments submitted by a person objecting to the proposed agency action must be mailed within 30 days of receipt of the notice of proposed agency action which will be presumed in the absence of evidence to the contrary to be five days after the date on the notice of proposed agency action. The objections must include a written statement detailing the specific items in the notice of proposed agency action to which the person objects.

(3) For good cause shown, the department may extend the 30-day period.

(4) After review of the documentation or arguments submitted against the proposed agency action, if any, the department may issue a notice of agency action.

(b) Notice of agency action. (1) If after its review, the department determines to sanction a person or to recover overpayments, it will send a written notice of agency action advising the person of the final determination at least 20 days before the action becomes effective.

(2) The notice of agency action must state:

(i) the reasons for the determination including the legal authority for the action;

(ii) the effective date of the action;

(iii) the effect of the sanction upon the person's participation in the medical assistance program and the amount of any overpayment to be recovered;

(iv) the earliest date on which a request for reinstatement may be made;

(v) the requirements and procedures for reinstatement; and

(vi) the right of the person to appeal the determination and the requirements and procedures for requesting an administrative hearing.



VOLUME C (Title 18)