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Ch. 105
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640
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LAWS OF MARYLAND
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(ii) 1 shall be chosen by the appointed
members.
(4) Of the 2 appointed members of a board:
(i) 1 shall be a representative of the industry
affected who is an individual knowledgeable in Medicare and
Medicaid reimbursement principles; and
(ii) 1 shall be an individual who is employed
by this State and knowledgeable in Medicare and Medicaid
reimbursement principles and who does not participate directly in
the field verifications.
(c) If the Department or an agent of the Department does a
field verification of the costs and allowable charges of a
hospital, intermediate care facility, or skilled nursing facility
that participates in the Program, the Department or agent shall
notify the hospital or facility of the results of the field
verification.
(d) (1) A hospital or facility may appeal the results of a
field verification by filing written notice with the appropriate
board within 30 days after the hospital or facility receives the
notice from the Department or its agent.
(2) IF A FACILITY OTHER THAN A HOSPITAL, OR IF THE
DEPARTMENT IS AGGRIEVED BY A FINAL DECISION OF THE BOARD UNDER
THIS SECTION, THE FACILITY OR THE DEPARTMENT SHALL PLACE ANY
MONEY DUE FROM THE FACILITY OR FROM THE DEPARTMENT IN AN INTEREST
BEARING ESCROW ACCOUNT. THE MONEY SHALL REMAIN IN ESCROW UNTIL A
FINAL DECISION HAS BEEN RENDERED.
(3) UPON A FINAL DETERMINATION OF THE DISPUTE, THE
APPROPRIATE PERSON ADMINISTERING THE ESCROW ACCOUNT SHALL
DISTRIBUTE THE MONEY IN THAT ACCOUNT, INCLUDING ANY INTEREST
ACCRUED, IN CONFORMITY WITH THE FINAL DETERMINATION.
(e) (1) After the Department receives the findings of a
board, the Department shall determine the amount that is due to
this State and notify the hospital or facility of that amount.
(2) Within 60 days after notification, the hospital
or facility shall pay the amount due the Department. After the
60-day period ends, the Department, in addition to any other
rights or remedies that may be available, shall recover the
unpaid balance by withholding up to 20 percent from payments that
otherwise would be due or payable to the hospital or facility.
(F) (1) ANY PERSON HOSPITAL OR FACILITY AGGRIEVED BY A
FINAL REIMBURSEMENT DECISION OF THE BOARD UNDER THIS SECTION MAY
NOT APPEAL TO THE BOARD OF REVIEW BUT MAY TAKE A DIRECT JUDICIAL
APPEAL.
(2) THE APPEAL SHALL BE MADE AS PROVIDED FOR JUDICIAL
REVIEW OF FINAL DECISIONS IN THE ADMINISTRATIVE PROCEDURE ACT.
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