Sec. 10.01.04.10. Benefits During Appeals Process

A. Benefits Pending Outcome of the Hearing.

(1) The Program may terminate or reduce services effective as of the date specified in the notice if the Program timely mails the notice as required under Regulation .03 of this chapter and:

(a) The appellant or the appellant’s authorized representative does not timely request a hearing in accordance with Regulation .04 of this chapter; or

(b) The appellant or the appellant’s authorized representative withdraws in writing or abandons a request for a fair hearing.

(2) Except as provided in §A(3) of this regulation, the Program may not terminate or reduce services until a decision is rendered after the hearing if:

(a) The Program timely mails the notice as required under Regulation .03 of this chapter; and

(b) The appellant requests a hearing before the date specified in the notice.

(3) The Program may terminate or reduce services before an administrative law judge renders a decision after a hearing if:

(a) The administrative law judge determines at the hearing that the sole issue is one of federal or State law or policy, or the request for a fair hearing is withdrawn in writing or abandoned; and

(b) The Program includes in the notification required by Regulation .03 of this chapter that services are to be terminated or reduced pending the hearing decision.

(4) The MCO shall continue benefits pending the outcome of the State fair hearing as described in COMAR 10.67.09.05F.

B. Reinstating Benefits.

(1) If the Program terminates or reduces services pursuant to §A of this regulation, the Program may reinstate services if a Program recipient requests a hearing not more than 10 days after the date specified in the notice.

(2) The reinstated services shall continue until a hearing decision, unless, at the hearing, the administrative law judge determines that the sole issue is one of federal or State law or policy.

(3) The Program shall reinstate and continue services until a decision is rendered after a hearing if:

(a) Action is taken without the advance notice being given to the recipient as required by Regulation .03 of this chapter;

(b) The recipient requests a hearing within 10 days of the mailing of the notice; and

(c) The Program determines that the action resulted from other than the application of federal or State law or policy.

(4) If a recipient's whereabouts are unknown, as indicated by the return of unforwardable Program mail directed to the recipient, any discontinued services shall be reinstated if the recipient’s whereabouts become known during the time the recipient is eligible for services.

(5) The administrative law judge may provide for an additional period during which time the request for a fair hearing will result in reinstatement of a recipient’s assistance to be continued until the hearing decision.