37.5.318    ADMINISTRATIVE REVIEW

(1) Upon the request for a hearing by a claimant or a provider, other than a medical assistance provider, the department shall conduct an administrative review with the purpose of resolving the case and avoiding an unnecessary hearing. This review may be conducted in person or by telephone. In person reviews shall be conducted at a place designated by the reviewer and reasonably convenient to the claimant or as designated by the hearing officer.

(a) No administrative review is required by this rule:

(i) if the department provides by other rule for an administrative review or other substantially equivalent process prior to a hearing request. If the department provides by rule for such a process, a hearing may not be granted unless the claimant or provider has exhausted the process in a timely manner; or

(ii) in any of the following matters:

(A) hearings pursuant to ARM 37.5.105 contesting a transfer or discharge of a nursing facility resident by a nursing facility;

(B) hearings pursuant to the Youth Access to Tobacco Act, Title 16, chapter 11, part 3, MCA;

(C) as otherwise provided by department rule.

(2) An administrative review includes:

(a) an informal conference with the department, subject to (3); and

(b) a review of relevant facts, legal authority and circumstances involved in the adverse action by the department and the preparation of an administrative review report for submission to the hearing officer within 20 days from the date the request for administrative review is mailed from the hearing officer to the person responsible for conducting the review, or within such other longer period specified by the hearing officer or agreed upon by the parties.

(3) The department official designated to conduct the administrative review may schedule the administrative review conference and must notify the claimant or provider of the date, time and place of the conference. If the claimant or provider cannot appear at the date and time set for the conference, the claimant or provider shall be given a reasonable opportunity to reschedule the conference. An additional opportunity or opportunities to reschedule may be granted for good cause shown.

(a) The conference shall be conducted at the office of the department official designated to conduct the administrative review, or may be conducted telephonically.

(b) The notification of the date, time, and place may inform the claimant or provider that if the claimant or provider fails to appear at the date, time, and place scheduled or fails to cooperate reasonably in scheduling and completing the conference, the conference will not be rescheduled and the administrative review report will be completed without a conference.

(c) The official designated to conduct the administrative review may proceed to conduct and complete the administrative review report without a conference if:

(i) the notification permitted by (3)(b) has been provided and the claimant or provider does not appear at the conference at the time scheduled and the conference has not been rescheduled; or

(ii) the claimant or provider does not cooperate reasonably in scheduling and completing the conference.

(4) An adverse action may be reversed or modified by the department or its designee at any time before, during or after the administrative review, in which case a hearing will not be held unless the claimant or provider is aggrieved by the modified adverse action and requests that the hearing be held.

(a) If the adverse action is modified or reversed by the department and the benefits which are the subject of the adverse action include county funds, a county human services or welfare office may request the hearing officer to hold the hearing if it is aggrieved by the action of the division administrator.

History: 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA; IMP, 53-2-201, MCA; NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1985 MAR p. 943, Eff. 7/12/85; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.