New York Codes, Rules and Regulations (NYCRR)
Title 9 Part 9750
Executive Department
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5 sections
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9 NYCRR 9750.1 - Introduction
Later State Register activity may affect this section.
Dates and status
- NYCRR title agency
- Executive Department
- Section status
- Section source receipt
- Source version current through
- May 15, 2022
All decisions issued after a request for a fair hearing are governed by this Part.
9 NYCRR 9750.2 - Decision after hearing
Later State Register activity may affect this section.
Dates and status
- NYCRR title agency
- Executive Department
- Section status
- Section source receipt
- Source version current through
- May 15, 2022
(a)The hearing decision shall be made and issued in accordance with the agreement between the Department of Health and the panel, and shall be based exclusively on the record and testimony introduced at the hearing.
(b)The decision shall be issued as promptly as feasible and within 60 days from the date the request for a fair hearing is received by the department. The decision shall describe the issues, recite the relevant facts, the pertinent provisions of law, regulation and State-approved policy, make appropriate findings, determine the issues, state reasons for the determinations and, when appropriate, direct specific action.
(c)Where the issue at hearing involves the mere calculation of income or determination of the amount of any required fee, premium or deductible paid or to be paid, the hearing officer may issue a directive on the record, directing specific action by the contractor. Where such immediate directive is issued, a written memorandum decision shall be made setting forth the directive.
(d)The decision shall be binding on the parties.
(e)A copy of the decision or the memorandum of an immediate directive issued on the record, as appropriate, shall be sent to each of the parties and their representatives, if any.
(f)In the letter transmitting the decision, clear reference shall be made to availability of judicial review.
9 NYCRR 9750.3 - Decision without hearing
Later State Register activity may affect this section.
Dates and status
- NYCRR title agency
- Executive Department
- Section status
- Section source receipt
- Source version current through
- May 15, 2022
(a)The appellant shall have the option to request that his/her appeal from a contractor's determination after reconsideration be decided without a hearing. Such request will be granted when it is determined that no unresolved material issue of fact is involved in the case and that the only questions presented are questions of law. A request for a decision without a hearing must be accompanied by sufficient information to ascertain whether any unresolved material issue of fact exists, and should contain a full and clear statement of the issue and the appellant's position on the issue.
(b)Upon receipt of a request for a decision without a hearing which presents, on its face, no factual dispute, a copy of the request and any supporting documents will be sent to the contractor. Within 10 working days of its receipt of the documents submitted by the appellant, the contractor shall forward, to the hearing officer, the appellant and the appellant's representative, its response containing sufficient information to ensure resolution of the dispute.
(c)The hearing officer shall make any further inquiries of the appellant, the appellant's representative and the contractor which are necessary to resolve the issues involved.
(d)If at any point after a request for a decision without a hearing is received, it appears that there is a material and unresolved issue of fact relating to the issue or issues upon which the hearing has been requested, the hearing officer shall inform the parties that a full hearing in accordance with the provisions of this Part must be scheduled to resolve the dispute, and the appellant shall then have the option of proceeding with such hearing or withdrawing the request for review.
9 NYCRR 9750.4 - Correction of error
Later State Register activity may affect this section.
Dates and status
- NYCRR title agency
- Executive Department
- Section status
- Section source receipt
- Source version current through
- May 15, 2022
When a fair hearing decision has ordered the correction of a discontinuance, the correction of a denial of an application for benefits or the correction of the amount of cost-sharing responsibilities, a payment shall be made to the appellant to cover the full amount to which he/she was entitled in accordance with the decision for the entire period from the date the incorrect action was taken.
9 NYCRR 9750.5 - Compliance with decision
Later State Register activity may affect this section.
Dates and status
- NYCRR title agency
- Executive Department
- Section status
- Section source receipt
- Source version current through
- May 15, 2022
(a)When a decision directs the contractor to perform specific actions, the contractor shall comply within 10 calendar days with such direction.
(b)The appellant for whose benefit such direction was given shall address any inquiry concerning contractor compliance to the panel's executive director who shall ascertain compliance with such direction by such means as the executive director may deem necessary and appropriate under the circumstances of the case.