4815 APPEAL OF ADJUSTMENTS TO THE SPECIFIC HOSPITAL COST PER DISCHARGE OR ADD-ON PAYMENTS

4815.1 After completion of a review or audit of the hospital's cost report for the base year, DHCF shall provide the hospital a written notice of its determination of any adjustment to the Hospital's Specific cost per discharge, direct medical education add-on payment or capital add-on payment for the base year. The notice shall include the following:

1. (a) A description of the rate adjustment, including the amount of the old payment rate and the revised payment rate;
2. (b) The effective date of the change in the payment rate;
3. (c) A summary of all audit adjustments made to reported costs, including an explanation, by appropriate reference to law, rules, or program manual of the reason in support of the adjustment; and
4. (d) A statement informing the hospital of the right to request an administrative review within sixty (60) days after the date of the determination.

4815.2 A hospital that disagrees with an audit adjustment or payment rate calculation for the Hospital Specific cost per discharge, capital add-on, or graduate medical education add-on costs shall submit a written request for administrative review to the Agency Fiscal Officer, Audit and Finance Office, DHCF.

4815.3 The written request for the administrative review shall include a specific description of the audit adjustment or payment rate calculation to be reviewed, the reason for review of each item, the relief requested, and documentation to support the relief requested.

4815.4 DHCF shall mail a formal response of its determination to the hospital not later than one hundred twenty (120) days after the date of the hospital's written request for administrative review.

4815.5 Within forty-five (45) days after receipt of the DHCF's written determination, the hospital may appeal the written determination by filing a written notice of appeal with the Office of Administrative Hearings.

4815.6 Filing an appeal with the Office of Administrative Hearings shall not stay any action to adjust the hospital's payment rate.

SOURCE: 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, 4334 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012).