A.(1)  An informal reconsideration shall constitute final action by the department except in those complaints in which the health standards section of the bureau of health services financing determines that the complaint concerns a consumer in a facility and involves issues that have resulted or are likely to result in serious harm or death to the consumer. In those complaints involving the issues of serious harm or death, as determined by the health standards section, the complainant or the provider may appeal the informal reconsideration finding to the division of administrative law.  All appeals and hearings shall conform with the Administrative Procedure Act and rules established by the department and the division of administrative law.

(2)  For purposes of this Section, “serious harm” is an incident which involves unconsciousness; physical pain evidenced by objective findings; disfigurement; loss or impairment of the function of a body member, organ, or mental faculty; or severe emotional distress.

B.  The hearing by the division of administrative law shall be limited to the evidence presented at the informal reconsideration unless the complainant or provider has obtained additional evidence important to the issues which he could not have with due diligence obtained before or during the informal reconsideration.

C.  An administrative law judge shall make a determination on the appeal based on the evidence presented as to whether the investigation was conducted properly or improperly.  If the administrative law judge determines that the investigation was not conducted properly, he shall designate in writing and with specificity the methods by which a reinvestigation shall be conducted.  No appeal shall lie from a reinvestigation upon a prima facie showing that the reinvestigation was conducted in accordance with the designations of the administrative law judge.

Added by Acts 1978, No. 687, §2.  Acts 1997, No. 1002, §1; Acts 2014, No. 812, §2, eff. June 23, 2014.