048.0037.4.9
Ch. 4, § 9. Maintaining Services Pending Appeal
Cite as Medicaid Rules, Ch. 4, § 9
(a) If the Department mails the required notice and the client requests a hearing before the effective date of the action, the Department may not terminate or reduce services until the final decision is rendered after the hearing unless:
(i) The Hearing Officer determines at the hearing that the sole issue is one of federal or state law or policy; and
(ii) The Department promptly informs the client in writing that services are to be terminated or reduced pending the final decision.
(b) If the adverse action is affirmed, the Department may institute recovery procedures against the client to recoup the cost of any services or goods furnished to the client, to the extent they were furnished solely by reason of this section, and may recover any overpayments made to a provider pursuant to 42 C.F.R. § 431.230(b).
(c) The Department shall reinstate and continue services until a decision is rendered if the action resulted from other than the application of federal or state law or policy pursuant to 42 C.F.R. § 431.231(c)(3).