Formal Provider Appeals

Formal Appeals - Formal appeals are also governed by the regulations at 1 Pa. Code, Chapters 31, 33, & 35, but are generally more complex than non-recipient appeals. Issues range from Child Abuse Expunctions to Medical Assistance Provider audit filings to licensure issues. Hearings are normally held face-to-face with a stenographer present to record the proceedings. These hearings take on a true court-like atmosphere. The Formal Appeals Unit, operating in the Harrisburg Headquarters Office, is responsible for processing of these appeals and scheduling hearings for them.

"Formal Appeals" refers to approximately 100 jurisdictional issues concerning the Department of Human Services (or the Department of Aging) but not relating to benefits for individual recipients or applicants, such as Cash Assistance or Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as Food Stamps.

The following is a summary listing of the general categories of appeals processed by the Formal Pre-Hearing Unit:

  • Act 142 Medical Assistance Provider appeals
  • Act 534 - Denial or termination
  • Adoption - Assistance waiver; denial of approval; denial of subsidy
  • Audit - Appeal from an audit determination
  • Child Abuse - Appeal from a report of child abuse; child abuse report expungement
  • Foster Care - Denial of approval as a foster care home; relocation of a child in foster care
  • Licensure - Child Day Care Facility Licensure denial or revocation; issuance of a provisional license to operate a child day care, personal care boarding home, or mental health/mental retardation facility
  • MA Preclusion - Preclusion by the Department of Human Services for health care providers to participate in the PA Medical Assistance Program
  • Aging - Report of elder abuse; pharmacy appeals relating to the PACE program

The Formal Pre-Hearing Unit is responsible for the pre-hearing processing of all formal type appeals received by BHA. Pre-hearing processes include: pre-screening for adherence to state and federal filing requirements, docketing, data entry, scheduling and conducting telephonic pre-hearing conferences and possibly a timeliness hearing. If a full hearing on the merits is needed, the date of such a hearing may be determined during the pre-hearing conference. Formal notices of a hearing are sent to the parties regarding the date, time, and location of the hearing. The file and all accompanying documentation are forwarded to the appropriate region prior to the hearing date.

The Administrative Regional Manager oversees this unit which consists of four Administrative Law Judges, three Legal Assistants 2 (Formal Docketing Coordinators), and two Legal Assistants who work together to ensure the timely and proper handling of formal appeals received by the BHA.

To determine if you have the right to appeal and/or if BHA has jurisdiction over the matter which you dispute, reference Pennsylvania regulations at www.pacode.com or www.pabulletin.com.

Act 142

You can search Bureau of Hearings and Appeals decisions on Medical Assistance provider appeals. Most of the documents listed in this search are in Portable Document Format. If you have trouble accessing this information you may obtain an alternative format by contacting the Bureau of Hearings and Appeals (717-783-3950) and requesting a publication

Standing Practice Order - Formal Appeals - Provides information and instruction regarding the pre-hearing procedures for matters that have been docketed as Formal Appeals before the Bureau of Hearings and Appeals. This document also contains a list of Legal Services Corporations.

Medical Assistance Provider Appeals (after 11/24/06) - Establishes rules governing practice and procedure in Medical Assistance provider appeals.  Note:  Any Medical Assistance Provider appeals filed between 7/1/03 and 11/24/06 would follow a Standing Practice Order.  Please contact the Bureau of Hearings and Appeals for a copy. 

55 Pa. Code Chapter 41
Procedure for Telephonic Testimony in Formal Cases
Unified Pre-Hearing Filing Instruction Sheet
Unified Pre-hearing Filing - Child Abuse Expunction