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PRRB Review

Live/Record Hearing Procedures & Evidence

I.  LIVE/TELEPHONIC HEARING PROCEDURES (Revised March 2013)

APPEARANCES – See Rule 30

Please note that once a Notice of Hearing is issued, there will be no further notification about the hearing to the parties before the scheduled hearing.  Failure to appear without a good cause finding by the Board may result in dismissal of your case will prejudice.  If an emergency arises which prevents your appearance, request a continuance immediately. 

 

WITNESSES – See Rule 28

 

EXPERT WITNESSES – See Rule 34

 

CONDUCT OF HEARING – See Rule 33

A hearing is an adversary proceeding.  Each party will have the opportunity to present its position.  Each party has the right to present and to cross-examine witnesses.  Evidence may be accepted even though inadmissible under the rules of evidence applicable to court procedures.  The Board determines the order in which arguments, evidence and testimony is presented.  Courtroom etiquette should be observed at all times.  Stipulations to fact by the parties are encouraged and should be offered by the parties after completion of opening statements.

 

Generally, hearings are completed in one day or less.  If the case involves multiple issues which the parties have not resolved and thus will be heard by the Board, the parties should ask the Board to schedule multiple days for the hearing.  If a hearing scheduled for only one day has not concluded at the end of the day the Board will, however possible, reconvene the hearing on the next business day.

 

REPRESENTATION –

A party may appoint legal counsel or any other person to act as representative, which includes the right to present evidence and arguments.

 

DOCUMENTS AND EXHIBITS – See Rules 27 and 35

Both parties are required to exchange with each other all correspondence, position papers, documents and exhibits concurrently with their submission to the Board.  Such materials will become part of the hearing record.  Parties are required to discuss and resolve questions associated with the documentation prior to the hearing.  Provider documents should be marked P-1, P-2, etc. in sequence.  Intermediary documents are to be marked I-1, I-2, etc. in sequence.  Also, parties are to submit an index that identifies each exhibit and the corresponding issue it supports.

 

All exhibits and /or documentation must be exchanged by the parties and submitted to the Board  7 - 10 business days prior to the date of the hearing.  Late submissions are disfavored and will not be accepted without good cause demonstrated to the satisfaction of the Board.  In the event it is absolutely necessary to introduce documentary evidence at the hearing, that party must:  (a) satisfy the Board of the necessity of the late submission; (b) provide a complete set of all such documentation to the other party as soon as possible, but prior to the hearing; and (c) provide 6 copies for distribution at the hearing.

 

CONFIDENTIAL INFORMATION –

Because the record in Board proceedings can be disclosed to the public, the parties should carefully review their documents to ensure that the documents do not contain patient names, health insurance or social security number, or other information that identifies an individual.

 

If such material is needed to support an argument, the respective party must redact (untraceably remove) the identifying information and use a system on non-identifying sequential numbering.  The parties must certify to the Board that they have reviewed the original materials and that the redacted documents have been properly prepared.  If the parties cannot certify the redacted documents, they must submit a sealed envelope with a cross-reference from the sequential numbers to the patient names, numbers or other identifying information with the redacted documents.  The Board will not accept documents that do not comply with this instruction.

 

II.  PRESENTATION OF EVIDENCE TO THE BOARD (Revised March 2013)

The following are the Board's suggestions for facilitating presentation of evidence and developing a complete record:

 

  1. Voluminous documents:  If the Board has to fumble through exhibits to keep up, it slows the hearing, interrupts the train of thought and distracts from the points you are trying to make.
  2. Separate exhibits with tabs.
  3. Number the pages of exhibits that exceed three pages.
  4. Don't bind documents so that some text is unreadable or so that the pages cannot be opened without the binder falling apart.  Although the Board's instructions state that the official, permanent record submission of position papers and exhibits should not be in a loose-leaf notebook, the extra copies for each Board member may be in notebooks.
  5. If you have multiple bound submissions, use different color binders for easy identification.
  6. If a document has data or language you will be referring to often, consider preparing a blowup exhibit of that part.
  7. If some documents will be referred to frequently or you will be going back and forth between several documents, consider making a "frequent exhibit," or excerpts of exhibits submission for each Board member and the opponent.  Label them the same as the exhibits in the record and highlights.
  8. Use summaries to present voluminous data.  Summaries must be presented sufficiently in advance to your opponent to allow analysis of the source data to be sure the summary accurately represents the source data. Source data must be part of the record unless the parties stipulate that the summary fairly represents the source data.
  9. Know what you must prove to win.  Be able to list disputed material facts and what evidence supports each.
  10. If essential exhibits are not self-explanatory or the information contained in the exhibit is in dispute, assure that a witness who has personal knowledge can explain it on direct examination and answer questions on cross exam.  For example, don't have a financial consultant describing state survey or JHCHO requirements for nursing staff ratios.

 

III.  RECORD HEARINGS (Revised March 2013)

TYPE OF CASES – See Rule 32.3

In cases involving only legal interpretation or very limited fact disputes, and the parties agree that the case is appropriate for a record hearing, the Board may approve the parties’ request to submit their case only on the existing written record.  Generally, record hearings are inappropriate when material facts are disputed and/or the credibility of witnesses may be an issue.  After approving the request, if the Board concludes that a case is not suitable for a record hearing, the Board will reset the case for an in-person or telephonic hearing.

 

RECORD REQUIREMENTS –

To be approved for a record hearing, the record must be complete and well organized.  Position papers must clearly reference specific evidence on which the parties rely, including the exhibit number and page.  The record must contain stipulations regarding all undisputed facts and principles of law.  See also DOCUMENTS AND EXHIBITS and CONFIDENTIAL INFORMATION above.