Human Services

Medical Assistance

SECTION 40-8-21

§ 40-8-21. Appeals process.

(a) Any provider that is not in agreement, after being provided an exit audit conference or rate appeal conference, with a final rate of reimbursement assigned as a result of an audit for its base year, or with the application of the principles of reimbursement for an applicable year, may within fifteen (15) days from the date of notification of audit results or rate assignment, file a written request with the department for a review of the computation of the assigned rate. The foregoing right of appeal shall also apply to demonstrated errors made during the rate determination process.

(b) A review conference will be conducted within fifteen (15) days from the date of receipt of the written request by a designee assigned by the director of the department of human services. As a result of the review conference, the designee may modify the audit adjustments and/or the rate of reimbursement. The designee shall provide the facility with a written decision within thirty (30) days from the date of the review conference.

(c) Appeals beyond the review conference shall be in accordance with the provisions of chapter 35 of title 42. The facility shall file a written request for the hearing no later than fifteen (15) days after receipt of the review conference decision.

History of Section.
(P.L. 1993, ch. 138, art. 20, § 1; P.L. 2003, ch. 376, art. 41, § 3.)