1. A. The provider may seek an appeal from the imposition of any sanction. The appeal shall be filed with the DAL. For an appeal to be timely, it must be filed:

   1. 1. if an informal hearing was requested, 30 calendar days from the mailing of the results of the informal hearing, or
   2. 2. if an informal hearing was not requested, 30 calendar days from the mailing of the notice of action.
2. B. To be considered adequate, each appeal must specify the basis for the appeal and the actions being challenged. Each challenged finding and the basis for the challenge must be separately stated in the appeal.

3. C. Except for a permissive exclusion, the lodging of a timely and adequate request for an administrative appeal does not affect the imposition of a sanction.

   1. 1. All sanctions imposed are effective upon the mailing of the informal hearing results.
   2. 2. If an informal hearing is not requested, the sanctions are effective upon the expiration of time to request in informal hearing.

4. D. In the case of an exclusion, the BHSF director and the PIU section chief may suspend the provider during the pendency of the appeal if:

   1. 1. it is determined that allowing the provider to participate during the pendency of the appeal threatens the Medicaid program’s fiscal or programmatic integrity; or
   2. 2. the continued participation of the provider poses a threat to the health, welfare, or safety of any recipient.

5. E. If the exclusion is mandatory, a threat to the Medicaid program or recipients is presumed.

   1. 1. The “threat” determination shall be made following the informal hearing.
   2. 2. If no informal hearing is requested, the determination shall be made after the delay for requesting an informal hearing has passed.
6. F. Failure to lodge a timely and adequate request for an administrative appeal results in the imposition of all sanctions noticed in the informal hearing results. If an informal hearing was not requested, all sanctions in the original notice of action are effective upon the expiration of time to file an appeal.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and 46:437.1-46:440.3.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 52:698 (May 2026).