Section 47. Any applicant for or recipient of medical assistance, or the legal representative of such applicant or recipient, aggrieved by the failure of the division to grant medical assistance or by the failure of the division to approve or reject an application within the time limits established by section twenty-one or by the withdrawal of such assistance shall have a right to a hearing, after due notice, upon appeal to the division in the manner and form prescribed by the division; provided, however, such appeal is received by the division within thirty days after official notice of the action taken by the division has been received by the applicant or recipient. Such hearing shall be conducted by the commissioner of medical assistance or a referee designated by the commissioner within the board of hearings established under section forty-eight. The commissioner or the designated referee is hereby empowered to subpoena witnesses, administer oaths, take testimony and secure the production of such books, papers, records and documents as may be relevant to such hearings. The decision of the commissioner, or of the designated referee, small be the decision of the division. Such appeals, hearings, and decisions shall be subject to the provisions of section forty-eight.
The division may make such additional investigation as it may deem necessary and shall make such decision as to the granting of medical assistance and the amount of such assistance to be granted as in its opinion is justified and in conformity with the provisions of this chapter. Applicants or recipients affected by such decisions of the division shall, upon request, be given reasonable notice and opportunity for a hearing as provided under this section. The provisions relating to the conduct of hearings and decisions thereon made, as provided in this section, shall be equally applicable in all cases wherein the division acts upon its own motion.
The commissioner, or the referee designated by the commissioner, shall render and issue his or her decision within ninety days after the date of the filing of the appeal by the aggrieved applicant, or legal representative of an applicant. The commissioner, but not his or her designee, may for good cause shown, direct the director of the board of hearings to conduct a rehearing of the appeal. An order for such rehearing shall not be construed as indicating or implying any position by the commissioner on the merits of the appeal. The director shall send seven days' written notice to all parties, including the date, time and place of such rehearing, which shall be held at a location convenient to the person appealing, and after such rehearing the director may, not later than thirty days after the order for such rehearing, issue a superseding decision.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 118e - Division of Medical Assistance
Section 2 - Established Authority
Section 2a - Director of Dental Services
Section 6 - Medical Care Advisory Committee; Member; Staff; Report From Office of Medicaid
Section 8a - Definitions for Secs. 13c to 13k and Secs. 64 to 70
Section 9a - Masshealth; Beneficiaries; Eligibility; Payment; Information Applications
Section 9f - Duals Demonstration; Review of Request for Financial Solvency
Section 10 - Medical Care Assistance Program for Pregnant Women and Infants
Section 10a - Required Coverage for Prenatal Care, Childbirth and Postpartum Care
Section 10b - Required Coverage for Newborn Hearing Screening Tests
Section 10d - Required Coverage for Treatment of Breast and Cervical Cancer
Section 10g - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate
Section 10k - Coverage for Certain Services and Contraceptive Methods
Section 10m - Coverage for Tobacco Use Cessation Counseling and Products
Section 10n - Urgent Care Facilities; Referrals; Primary Care Providers
Section 11 - Cooperation With Federal Authorities
Section 12 - Policies; Procedures; Rules and Regulations; Contracts
Section 12a - Pharmaceutical Drugs; Negotiation of Supplemental Rebate Agreements
Section 13 - Rate Changes; Review
Section 13a - Non-Acute Hospitals; Rates and Terms of Payment
Section 13b - Hospital Rate Increases; Quality Standards and Benchmarks
Section 13c - Establishment of Rates of Payment for Health Care Services
Section 13d - Duties of Ratemaking Authority; Criteria for Establishing Rates
Section 13e - Appeals of Interim or Final Rates
Section 13e1/2 - Contractual Arrangements With Acute and Non-Acute Hospitals
Section 13g - Hospital Assets Not to Be Considered as Resources for Purpose of Establishing Rates
Section 13h - Recipients of Benefits Under Chapter 117a
Section 13i - Patients With Foreign Residency
Section 13j - Health Maintenance Organizations; Contracting Rights
Section 13k - Adjustment of Facility's Rate
Section 13l - Restriction of Hospital Access to Discounted Purchase of Prescription Drugs
Section 14 - Nursing Home Negotiated Rate Contracts
Section 15 - Medicaid Benefits; Rules and Regulations; Managed Care; Personal Expenses
Section 16a - Medical Care and Assistance Program for Disabled Children
Section 16c - Child Health Insurance Program; Medical Benefits; Costs; Eligibility
Section 16d - Aliens or Persons Residing in United States Under Color of Law; Benefits
Section 17 - Reimbursements for Non-Generic Drugs
Section 17a - Emergency Services Provided to Beneficiaries for Emergency Medical Conditions
Section 18 - Medical Insurance Purchases for Persons Eligible for Assistance
Section 20 - Application; Forms; Application by Institution
Section 21 - Inquiry by Department; Notification of Applicant; Agreement
Section 21a - Medical Assistance Eligibility of an Institutionalized Spouse
Section 22 - Third Party Payments; Repayment; Assignment; Subrogation
Section 23 - Subrogation Rights; Health Insurance Benefits; Garnishment of Wages
Section 23a - Financial Institutions; Request for Deposit and Withdrawal Records; Penalty
Section 25 - Exempt Income and Resources
Section 26 - Identification Card
Section 27 - Redetermination of Eligibility
Section 28 - Disposal of Resources at Less Than Fair Market Value; Period of Ineligibility
Section 29 - Transfer of Interest in Real Property; Notice
Section 31 - Adjustment or Recovery of Payments
Section 33 - Long Term Care Insurance Purchasers; Liability for Medical Assistance Paid
Section 34 - Liens and Encumbrances
Section 35 - Reimbursement for Covered Claims; Submission of Information
Section 36 - Eligible Providers; Responsibility for Overpayments
Section 37 - Distribution of Rules, Regulations to Providers; Administrative Sanctions
Section 38a - Retroactive Claims Denials for Behavioral Health Services
Section 39 - False Representations, Failure to Disclose; Penalty
Section 40 - False Statements or Representations by Providers; Penalty
Section 41 - Bribery or Rebates; Penalty
Section 42 - Excess Charges; Penalty
Section 44 - Civil Remedies; Limitations
Section 45 - Venue; Actions Relating to False Claims
Section 46 - Availability of Other Remedies
Section 47 - Persons Aggrieved; Right to Hearing; Investigation; Decision; Rehearing; Notice
Section 48 - Board of Hearings
Section 49 - Use and Disclosure of Information
Section 50 - Contract for Administrative Functions; Underwriting of Program
Section 52 - Maintenance of Standards for Providers; Development of New Programs
Section 54 - Wellness Program for Masshealth Enrollees
Section 56 - Controlled Substance Management Program for Masshealth Enrollees
Section 63 - Assessment per Non-Medicare Reimbursed Patient Day
Section 64 - Definitions for Secs. 64 Through 69
Section 65 - Health Safety Net Office
Section 66 - Health Safety Net Trust Fund
Section 67 - Liability of Acute Hospital to Fund
Section 67a - Nonpublic Ambulance Services; Liability; Uniform Assessment; Enforcement
Section 68 - Surcharge Assessed by Acute Hospitals and Ambulatory Surgical Centers
Section 70 - Definitions for Secs. 70 Through 75
Section 71 - Pca Quality Home Care Workforce Council
Section 74 - Pca Quality Home Care Workforce Council; Scope of Power and Authority
Section 75 - Performance Reviews
Section 77 - Office of Medicaid to Attribute Members to Primary Care Providers