DEPARTMENT OF HEALTH AND HUMAN SERVICES  
MEDICAL SERVICES ADMINISTATION  
MSA PROVIDER HEARINGS  
(By authority conferred on the executive director of the department of  
health and human services by sections 6 and 9 of 1939 PA 280, MCL 400.6  
and 400.9, and Executive Reorganization Orders 2005-1 and 2011-4, MCL 445.2021 and  
445.2030)  
R 400.3401 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3402 Definitions.  
Rule 2. As used in these rules:  
(a)“Adverse action” means any of the following:  
(i) A suspension or termination of provider participation in the medical assistance  
program.  
(ii) A denial of an applicant’s request for participation in the medical assistance  
program.  
(iii) The reduction, suspension, or adjustments of provider payments.  
(iv) Retroactive adjustments following the audit or review and determination of the  
daily reimbursement rates for institutional providers.  
(b) “Applicant” means an individual, firm, corporation, association, agency,  
institution, or other legal entity that has applied to participate in the medical assistance  
program as a provider.  
History: 1979 AC; 2016 AACS.  
Editor's Note: An obvious error in R 400.3402 was corrected at the request of the promulgating  
agency, pursuant to Section 56 of 1969 PA 306, as amended by 2000 PA 262, MCL 24.256. The rule  
containing the error was published in Michigan Register, 2016 MR 10. The memorandum requesting the  
correction was published in Michigan Register, 2016 MR 12.  
R 400.3403 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3404 Request for internal conference or appeal for administrative hearing.  
Rule 4. (1) After notice of an adverse action, providers or applicants may request an  
internal conference or an appeal for administrative hearing.  
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(2) Providers and applicants must request an internal conference or an appeal for  
administrative hearing in writing which shall be received within 30 calendar days of the  
notice of adverse action unless otherwise specified in the notice of adverse action or if a  
different appeal period exists in state or federal regulations.  
(3) If a provider or an applicant does not timely request an internal conference or  
appeal for administrative hearing after receiving notice of an adverse action, the notice of  
adverse action is final and the department may act on it.  
History: 1979 AC; 2016 AACS.  
R 400.3405 Internal Conference.  
Rule 5. (1) Before a provider or an applicant requests an administrative hearing, a  
provider or an applicant may request an internal conference. The purpose of the internal  
conference is to determine whether the department action was taken according to policy.  
(2) The provider or applicant may meet with a department staff member who acts as  
the appeals review officer from the appeals section or its successor section. The staff  
member is an impartial arbiter who facilitates the communication and the exchange of  
information between the provider or applicant and the department program staff.  
(3) All requests for an internal conference must be submitted in writing to the  
department. The appeals review officer may deny requests for internal conferences  
received after 30 days or after the date specified in the notice of adverse action.  
(4) A request must state all of the following:  
(a) Item or items being appealed.  
(b) The dollar amount involved, if any.  
(c) All necessary documentation to support the reason for the internal conference.  
(d) Failure to follow the requirements in this subrule may result in the denial of the  
internal conference by the appeals review officer.  
(5) The appeals section must issue a decision within 30 days after the conclusion of  
the internal conference.  
(6) Should the provider, applicant, and/or the department disagree with the internal  
conference decision, the provider, applicant, and/or the department has the right to an  
administrative hearing. Requests for an administrative hearing must be in writing and  
made within 30 days of the decision of the internal conference decision.  
History: 1979 AC; 2016 AACS.  
R 400.3406 Formal hearing.  
Rule 6. (1) A provider or applicant is entitled to a formal hearing pursuant to  
chapter 4 of 1969 PA 306, MCL 24.271 to MCL 24.287, in any case in which there has  
been a final determination of an adverse action as defined in R 400.34012, except where  
that action is predicated upon the situation described in subrule (2) of this rule.  
(2) A request for a formal hearing shall not be granted if the adverse action is the  
result of the revocation, suspension, or termination, by an authority other than the  
department, of the provider's license or certification to practice in the provider's  
profession or to operate a nursing home, hospital, or other such medical facility,  
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and if the department is in receipt of a certified copy or formal notification of such  
revocation, suspension, or termination.  
(3) A formal hearing shall be granted if the revocation, suspension, or termination  
of the provider's license, certification, or authorization is the result of a department  
action, unless the provider previously had an opportunity to have that action reviewed.  
(4) Unless a written request for a formal hearing is received within 30 calendar days  
of notification of intent to terminate, the provider's participation shall automatically  
terminate as of the thirtieth calendar day after date of notification. Such termination shall  
then be a final and binding administrative determination.  
(5) The request shall identify all of the following:  
(a) Those aspects of the determination with which the provider or applicant is  
dissatisfied.  
(b) An explanation of why the provider or applicant believes the determination on  
those matters is incorrect.  
(c) The dollar amount, if any, involved.  
(6) The request shall be submitted with any documentary evidence the provider or  
applicant considers necessary to support its position.  
History: 1979 AC; 2016 AACS.  
R 400.3407 Suspension and adjustment of program payments.  
Rule 7. (1) Regardless of any request for a hearing, payments on pending and  
subsequently submitted bills may be immediately suspended, in whole or in part, if the  
bureau director determines that the practice set out in the final determination requires  
immediate action to protect the health, safety, or welfare of recipients or the general  
public. This subrule does not prejudice the provider's right to a hearing as provided in R  
400.3406. Any hearing requested pursuant to this subrule shall be commenced  
forthwith if requested by the provider.  
(2) The final determination notice shall constitute the basis for making retroactive  
adjustment of any program payments made to the provider during the period to which the  
determination applies, including the suspension of further payments to the provider, in  
order to recover, or to aid in the recovery of, an overpayment identified in the  
determination to have been made to the provider or applicant. If the provider or  
applicant requests a hearing, adjustments and recovery shall not be made, except as  
provided in subrule (1), until 10 days after the mailing of the hearing decision as  
provided in R 400.3424.  
History: 1979 AC.  
R 400.3408 Rescinded.  
History: 1979 AC; 2016 AACS.  
R 400.3409 Rescinded.  
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History: 1979 AC; 2015 AACS.  
R 400.3410 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3410 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3411 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3412 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3413 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3414 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3415 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3416 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3417 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3418 Rescinded.  
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History: 1979 AC; 2015 AACS.  
R 400.3419 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3420 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3421 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3422 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3423 Rescinded.  
History: 1979 AC; 2015 AACS.  
R 400.3424 Final decision of director or hearing authority.  
Rule 24. The director or hearing authority shall render a final decision in each case  
based upon the evidence in the record not later than 45 days after the administrative law  
judge makes his recommendation. The decision shall be made in writing. A copy of the  
decision shall be mailed to each party at the party's last known address. Copies of all  
decisions of the director or hearing authority shall be accessible to the public at the  
state office of the department. Copies may be obtained at actual cost.  
History: 1979 AC.  
R
400.3425  
Nonapplicability of rules to alternate method of hospital  
reimbursement.  
Rule 25. R 400.3401 to R 400.3423 do not apply to the alternate method of hospital  
reimbursement. That method shall follow the procedures in the approved state medical  
assistance plan.  
History: 1979 AC.  
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;