101 CMR 20.17 - 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, ยง
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.
Notes
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