Sec.17a-453a-17. Administrative hearing to appeal audit recovery or progressive sanctions

(a) Contracted providers have a right to an administrative hearing as follows:

(1) The contracted provider is subject to recovery of payments following an audit conducted by DMHAS or its designated agent as specified in section 17a-453a-16 of the Regulations of Connecticut State Agencies;

(2) The contracted provider is subject to progressive sanctions following an audit conducted by DMHAS or its designated agent as specified in section 17a-453a-16 of the Regulations of Connecticut State Agencies; and

(3) The commissioner has determined that the contracted provider's participation in the GABHP should be terminated for any of the reasons as specified in section 17a-453a-13(e) of the Regulations of Connecticut State Agencies.

(b) The contracted provider may request an administrative hearing in accordance with the following:

(1) For administrative hearing requests following a DMHAS audit where the contracted provider is subject to recovery of payment for an audit adjustment or progressive sanctions, the contracted provider's request for an administrative hearing shall be submitted in writing to the commissioner and contain a clear and concise statement of the issues the contracted provider seeks to address relating to the audit and, when applicable, the audit adjustment that is being sought by DMHAS. This request shall be submitted not more than (30) calendar days after the mailing date of notification from DMHAS of its intent to recover the audit adjustment or impose progressive sanctions on the contracted provider;

(2) For administrative hearing requests made by a contracted provider when the commissioner has determined that the contracted provider's contract to participate in the GABHP should be terminated for any of the reasons as specified in section 17a-453a-13(e) of the Regulations of the Connecticut State agencies, the contracted provider's request for an administrative hearing shall:

(A) Be submitted in writing to the commissioner, not more than thirty (30) calendar days after the mailing of notification from the commissioner of the decision to terminate the contracted provider's contract; and

(B) Contain a clear and concise statement of the issues that the contracted provider seeks to address.

(c) The commissioner may appoint an administrative hearing officer to provide the commissioner with a recommended decision.

(d) As soon as possible following receipt of an administrative hearing request the administrative hearing officer shall schedule an administrative hearing to be held not more than forty-five (45) calendar days after the date of the request, provided that if a request for an expedited hearing is made by a party, the administrative hearing officer shall attempt to expedite the administrative hearing if the administrative hearing officer determines that a delay would be significantly damaging to that party. An administrative hearing request shall be acknowledged by letter from the administrative hearing officer to the contracted provider, containing notice of the administrative hearing pursuant to section 4-177(b) of the Connecticut General Statutes.

(e) A request for an administrative hearing shall be disposed of only by one of the following definitive actions:

(1) Withdrawal of the request by the person who made it. This action shall be voluntary and may be made at any time prior to the administrative hearing by a written statement of withdrawal addressed to the commissioner. The withdrawal shall be acknowledged in writing by the administrative hearing officer and shall be the final action on the complaint.

(2) Dismissal of the request by the administrative hearing officer. This action may be taken if:

(A) The contracted provider fails to appear at the designated time and place, or

(B) The issue is resolved prior to or during the administrative hearing by voluntary agreement of both parties.

(3) Final decision by the commissioner after receiving a proposed decision from the administrative hearing officer following an administrative hearing. Nothing in this section shall preclude the issuance of any necessary interim order by the administrative hearing officer during the proceedings.

(f) The administrative hearing shall be conducted as a contested case under the provisions of Chapter 54 of the Uniform Administrative Procedure Act, sections 4-166 to 4-189, inclusive, of the Connecticut General Statutes. The contracted provider has the burden of proving by a preponderance of the evidence that a DMHAS decision as specified in section 17a-453a-17(a) does not comply with state or federal law or is clearly erroneous.

(g) All witnesses shall be under oath. The contracted provider may act as a witness on his or her own behalf and may bring additional witnesses. DMHAS and its designated agent may present witnesses.

(h) If a witness elects to retain possession of a document, a copy of the original may be admitted.

(i) The administrative hearing officer shall have the power to compel, by subpoena, the attendance and testimony of witnesses and the production of books and papers.

(j) The administrative hearing record shall consist of the administrative hearing request, notices issued by the administrative hearing officer, the transcript or recording of testimony, exhibits, all papers and requests filed in the proceeding, and the administrative hearing decision.

(k) Upon conclusion of the administrative hearing, the administrative hearing officer shall prepare a proposed written decision and shall mail it to the parties by certified mail, return receipt requested, as well as providing it to the commissioner. The proposed decision shall contain a statement of the reasons for the decision and a finding of facts and conclusions of law on each issue of fact or law necessary to the decision. Any party may, not more than fifteen (15) calendar days after the mailing of the proposed decision, provide the commissioner with written argument in support of, or in opposition to, the proposed decision and may request the opportunity for oral argument. The commissioner shall render a final decision which may, in whole or in part, modify or reject the proposed decision. A contracted provider aggrieved by the decision may appeal to the Superior Court pursuant to the provisions of section 4-183 of the Connecticut General Statutes.

(Adopted effective December 7, 2009)