4814 APPEALS FOR HOSPITALS THAT ARE COMPENSATED ON AN APDRG BASIS

4814.1 Hospitals that are compensated on an APDRG discharge basis shall receive Remittance Advice each payment cycle.

4814.2 Within sixty (60) days after the date of the Remittance Advice, any hospital that disagrees with the payment rate calculation for the amounts listed in subsection 4814.3 or the APDRG assignment shall submit a written request for administrative review to the Agency Fiscal Officer, Audit and Finance, DHCF.

4814.3 The amounts subject to an administrative review are as follows:

(a) Add- on payment for capital costs or graduate medical education costs; and

(b) Outlier payment.

4814.4 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 under subsection 4814.2.

4814.5 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.

4814.6 Filing an appeal with the Office of Administrative Hearings shall not stay an action to recover an overpayment to the hospital.

SOURCE: Final Rulemaking published at 46 DCR 8271, 8274 (October 15, 1999); 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, 4333 (May 20, 2011).