Definitions

Definitions The Division of Medicaid defines: A. Administrative Hearing as a trial-like proceeding before the Division of Medicaid at which evidence and testimony may be offered. B. Hearing Officer as the presiding officer appointed by the Executive Director or the Executive Director’s designee to conduct administrative hearings within the guidelines stated in this chapter. The Hearing Officer may: 1. Issue subpoenas, 2. Administer oaths, 3. Compel attendance and testimony of witnesses, 4. Require the production of books, papers, documents, and other evidence required, 5. Take depositions solely for the purposes of preserving testimony for the purposes of the administrative hearing, 6. Preserve and enforce order during the administrative hearing, 7. Call informal, status, or pre-hearing conferences, including for the purposes of handling procedural matters, 8. Invite stipulations between the parties, 9. Do all things conformable to law and Medicaid regulations that may be necessary to enable the Hearing Officer to effectively discharge the Hearing Officer’s duties, 10. State that exact costs, including but not limited to cost of the Hearing Officer, court reporter, attorney’s fees, third-party medical review, and any other cost borne by the Division in preparing for and conducting the hearing, be assessed to a losing provider as part of the recommendation to the Executive Director, and 11. Include the recommendation to the Executive Director that the Provider be terminated in cases of egregious behavior, such as fraud, waste, and abuse, and that the Provider be reported to HHS. C. Final Agency Action as the decision rendered by the Division regarding matters as defined under Rule 3.1.A of this Chapter to which the Provider may file an appeal with the Division. D. Final Decision as the decision rendered by the Division’s Executive Director after the completion of the Division’s appeal process.