Finding Comfort with the Georgia Medicaid Hearing Process When Denied/Terminated from Enrollment – A Case Example Involving a CCSP Provider

The Georgia Medicaid Manual explicitly states that administrative review is not applicable when a provider has been denied enrollment or terminated from the Medicaid program by the Georgia Department of Community Health (“DCH”). Rather, the provider must pursue adjudication before a hearing officer specifically designated by the DCH Commissioner. Thus, unlike Medicaid reimbursement disputes where administrative review is available before the Office of State Administrative Hearings (an impartial tribunal tasked with resolving disputes between the public and state agencies), a denied or terminated provider is presented with the daunting task of pleading its case before someone handpicked by the DCH Commissioner.

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