4813 APPEALS FOR HOSPITALS THAT ARE NOT COMPENSATED ON AN APDRG BASIS

4813.1 A hospital that is not compensated on an APDRG basis shall receive a Notice of Program Reimbursement (NPR) at the end of its fiscal year after a site audit.

4813.2 Within sixty (60) days after the date of the NPR, a hospital that disagrees with the NPR shall submit a written request for an administrative review of the NPR to the Agency Fiscal Officer, Audit and Finance, DHCF.

4813.3 The written request for administrative review shall include a specific description of the audit adjustment or estimated budget item to be reviewed, the reason for the request for review of the adjustment or item, the relief requested, and documentation in support of the relief requested.

4813.4 The Medicaid Program shall mail a written determination relative to the administrative review to the hospital no later than one hundred twenty (120) days after the date of receipt of the hospital's written request for administrative review.

4813.5 Within forty-five (45) days after receipt of the Medicaid Program's written determination, the hospital may appeal the written determination by filing a written notice of appeal with the Office of Administrative Hearings.

4813.6 Filing an appeal with the Office of Administrative Hearings shall not stay any action to recover any overpayment to the hospital. The hospital shall be liable immediately to the Medicaid Program for any overpayment set forth in the Medicaid Program's determination.

SOURCE: Final Rulemaking published at 45 DCR 4141, 4151 (June 26, 1998); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010)[EXPIRED]; as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010)[EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 4323, 4332 (May 20, 2011).