37.5.311    INFORMAL RECONSIDERATION

(1) A provider or other person may request an informal reconsideration of a department action in the following cases:

(a) where the hearing is to be held after the effective date of a denial, termination, or nonrenewal of enrollment, certification, or registration;

(b) where the department intends to withhold or suspend payments to a medical assistance provider pursuant to ARM 37.85.513; or

(c) as otherwise provided by department rule.

(2) The informal reconsideration includes:

(a) written notice to the provider of the department action and the findings upon which it was based, if not otherwise already provided;

(b) the provider's written refutation of the department's findings, which must be received by the department within 15 days after mailing of the department's notice under (2)(a); and

(c) the department's written determination modifying, affirming, or reversing its decision.

(3) This rule does not require that the informal reconsideration or any hearing be conducted prior to the department action.

(4) An informal reconsideration under this rule is not subject to the provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA.

(5) An informal reconsideration is a different and separate form of procedure from an administrative review and/or fair hearing. A provider or other person is not entitled to an administrative review, fair hearing, or other process in addition to an informal reconsideration unless specifically provided by department rule or otherwise required by law.

History: 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA; IMP, 53-2-201, MCA; NEW, 2000 MAR p. 1653, Eff. 6/30/00.