Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 704. Appeal procedures

7 AAC 43.704. Appeal procedures

(a) If a notice of appeal satisfies the requirements of 7 AAC 43.703, the department will file, in accordance with the prehearing schedule established under (c) of this section, and with both the hearing officer and the facility representative designated under 7 AAC 43.703(a) (4) or (b)(4) as the point of contact, a written response setting out the department's position with respect to each of the points raised in the appeal. In the response, the department will state clearly the defenses it intends to assert.

(b) Within 15 days after receiving a notice of appeal that satisfies the requirements of 7 AAC 43.703, the commissioner will assign the case to a hearing officer. The commissioner will send notice of the assignment to the assigned hearing officer, the department, and the facility representative designated under 7 AAC 43.703(a) (4) or (b)(4) as the point of contact. In the notice, the commissioner will state the date that the commissioner received the notice of appeal. The notice will be accompanied by a copy of the notice of appeal and any documents filed with the notice of appeal.

(c) Within 45 days after receiving the notice of assignment, the hearing officer shall conduct a prehearing conference, at which time a schedule shall be established that sets prehearing deadlines and a date for the hearing. The schedule shall provide for a hearing on the administrative appeal under 7 AAC 43.703(a) or (b) to begin within 120 days after the written notice of appeal was received by the commissioner, unless the facility requests a delay or the hearing officer finds good cause for the delay. The hearing officer may find good cause for the delay under AS 47.07.075 (b)(1) and this subsection in circumstances such as the following:

(1) the hearing officer finds that the facility waived its right to a timely hearing under this section;

(2) the parties stipulated to the hearing being held at a later date;

(3) the facility failed to file the statement of issues described in (a) of this section at the time that the notice of appeal was initially filed;

(4) the facility amended its statement of issues after initial filing;

(5) the hearing officer finds that strict adherence to the 120-day time limit for a hearing would work injustice.

(d) A facility may amend its original statement of issues once as a matter of course at any time before the department's response is filed. The department may amend its response to the facility's statement of issues, once within 20 days after the department's original response is filed. A party may amend the statement of issues or a response at other times only by leave of the hearing officer or by written consent of the opposing party. The hearing office shall freely grant leave to amend, if the hearing officer finds justice so requires. Unless the hearing officer orders otherwise, the department shall respond to an amended statement of issues within the time remaining for response to the original statement of issues or within 10 days after service of the amended statement of issues, whichever period is longer.

(e) Unless otherwise ordered by the hearing officer, discovery shall be permitted in accordance with a plan for discovery approved by the hearing officer.

(f) The hearing officer shall issue a proposed decision on the appeal within 180 days of the latest of the following events:

(1) completion of briefing on a dispositive motion, or oral argument on the motion, whichever is later;

(2) completion of the evidentiary hearing, including post-hearing briefing and argument, if any.

(g) If a proposed decision is not issued under (f) of this section within 180 days, the hearing officer shall inform the commissioner and the parties, in writing, as to the reasons for the delay. Failure to complete a proposed decision within 180 days does not affect the status of the administrative proceeding or the rights of the parties in the administrative proceeding.

(h) Unless otherwise specified by statute, regulation, or an order by the hearing officer, proceedings shall be conducted in accordance with the Alaska Rules of Civil Procedure. A party may file documents with the hearing officer by facsimile or other electronic means only if authorized by order of the hearing officer.

(i) Within 30 days after receiving the proposed decision of the hearing officer, the commissioner will issue a decision or refer the appeal back to a hearing officer for additional findings of fact or redetermination of the issues presented. The commissioner will provide copies of the commissioner's decision to the

(1) hearing officer

(2) facility representative designated under 7 AAC 43.703(a) (4) or (b)(4) as the point of contact;

(3) department staff that oversees Medicaid payment rates; and

(4) director of the division of the department responsible for paying Medicaid program claims.

(j) In making the report on noncompliance with the 120-day hearing time limit as required by AS 47.07.075 , the department will only include a hearing that did not comply with that time limit, if the time limit was not adjusted under (c) of this section.

History: Eff. 9/5/97, Register 143; am 1/1/2004, Register 168

Authority: AS 47.07.070

AS 47.07.075