Reconsideration and Appeals Process

(1) Applicability. The provisions set forth in 101 CMR 20.17 establish EOHHS’s review process for provider organization disputes concerning penalties associated with the requirement to connect to the Mass HIway as established by M.G.L c. 118I and 101 CMR 20.08. (2) Notice of Penalties. EOHHS will notify the provider organization in writing of EOHHS's determination of the provider organization’s failure to comply with the requirements to connect to the Mass HIway as established by 101 CMR 20.08. The notice will identify the penalty a provider organization must pay and identify the provider organization’s right to review. EOHHS will notify the provider organization by letter, report, computer printout, electronic transmission, or other format. This notification is the Mass HIway Notice of Penalties. (3) Requesting EOHHS Review of Penalties for Failure to Connect to the Mass HIway. (a) To preserve its right to an adjudicatory hearing and judicial review, a provider organization must request EOHHS’s review of the determination of a penalty as specified in the notice. A provider organization's request for review may be based on an alleged error in EOHHS’s determination of the provider organization's ability to connect to the Mass HIway as required under 101 CMR 20.08. The provider organization's request for review must be made in writing and be received by EOHHS within 30 calendar days of the date appearing on the Mass HIway Notice of Penalties. (b) A provider organization's request for review may request reconsideration of the provider organization's compliance with its selected use case(s) and penalty amounts. (c) Any request for agency review submitted pursuant to 101 CMR 20.17 must 1. identify with specificity all determinations with which the provider organization disagrees; 2. specify in sufficient detail the basis for the provider organization's disagreement with those determinations; 3. identify and address all issues in the Mass HIway Notice of Penalties with which the provider organization disagrees; and 4. include any documentary evidence and information that the provider organization wants EOHHS to consider. (4) EOHHS's Final Determination. (a) EOHHS will review a provider organization's request for agency review only if it is submitted in compliance with the requirements of 101 CMR 20.17. EOHHS is not obligated to consider any information or documents that the provider organization failed to timely submit in writing with the request for agency review and received by EOHHS within 30 calendar days of the date appearing on the Mass HIway Notice of Penalties. EOHHS will issue a final written determination of contested penalty assessments based on its review, which will state the reasons for the determination, and inform the provider organization of the provider organization’s right to file a claim for an adjudicatory hearing with the Board of Hearings established under M.G.L. 118E § 48. (b) Any findings specified in the Mass HIway Notice of Penalties that are not specifically identified as in dispute in a provider organization's request for agency review will, without further notice, constitute EOHHS’s final determination. The provider organization has no right to an adjudicatory hearing or judicial review of such findings because of the failure to exhaust its administrative remedies. (c) If the provider organization does not submit a request for agency review, the Mass HIway Notice of Penalties constitutes EOHHS’s final determination. If a provider organization requests agency review but fails to timely comply with the requirements of 101 CMR 20.17, the request for agency review may be denied. In either case, the Mass HIway Notice of Penalties constitutes EOHHS’s final determination, and the provider organization has no right to an adjudicatory hearing pursuant or judicial review because of the failure to exhaust its administrative remedies. (5) Appeal of EOHHS’s final agency action pursuant to 101 CMR 20.17(4)(a) will be permitted by filing a claim for an adjudicatory hearing with the Board of Hearings and EOHHS within 30 calendar days of the date on the final determination. A claim is considered to be filed on the date that it is actually received by both the Board of Hearings and EOHHS. Failure to file a timely claim will result in implementation of the action identified in the final determination.