Skip to main content

Library: Policy

3172-3-13. State fair hearing for providers

Issued 12-21-21

(a) Right to State fair hearing. With regard to provider audit findings, for-cause and immediate termination of the provider's agreement, and claims denial, a provider may request a State fair hearing within thirty (30) calendar days of the MCE's notice of appeal resolution when that resolution does not favor the provider.

(b) Information for providers. As a part of the MCE's provider complaint system, the MCE will provide information to providers on how to request a State fair hearing via filing the appropriate form with the OHCA Docket Clerk.

(c) MCE documentation obligation. The MCE will provide documentation to the provider, OHCA, and the Office of Administrative Hearings.

(1) Timing. The MCE will provide the documentation described in this subsection within fifteen (15) calendar days after notification of the request for State fair hearing.

(2) Information. Documentation will include, at minimum, the following information:

(A) The name and address of the provider;

(B) A summary statement concerning why the provider has filed a request for State fair hearing;

(C) A brief chronological summary of the MCE's action in relationship to the matter underlying the provider's request for State fair hearing;

(D) The provider's appeal request, along with any supporting documentation, if received by the MCE;

(E) Any applicable correspondence between the MCE and the provider, including system notes entered by one or more MCE employees based on one or more telephone conversations with the provider;

(F) All exhibits offered at any hearing held with the MCE;

(G) All documents the MCE used to reach its decision;

(H) A statement of the legal basis for the MCE's decision;

(I) A citation of the applicable policies and/or legal authorities relied upon by the MCE in making its decision;

(J) A copy of the notice which notified the provider of the decision in question;

(K) The names and titles of any MCE employees who will serve as witnesses at the State fair hearing; and

(L) Any other information requested by the provider, OHCA, or the Office of Administrative Hearings when the information relates to the State fair hearing or any matter giving rise to the State fair hearing.

Back to Top