Wyo. Code R. 048-0037-19
Medicaid
Chapter 19: Nursing Facility Preadmission Screenings
Effective Date: 11/18/1997 to 05/29/2012
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0037.19.11181997
This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W.S. 42-4-101 et seq. and the Wyoming Administrative Procedures Act at W.S. 16-3-101 et seq.
(a) This Chapter establishes methods and standards for preadmission screening of patients and prospective patients of nursing facilities. The requirements of this Chapter apply to all patients and prospective patients, regardless of payment source.
(b) The Department may issue Provider Manuals, Provider Bulletins, or both, to interpret the provisions of this Chapter. Such Provider Manuals and Provider Bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in Provider Manuals or Provider Bulletins shall be subordinate to the provisions of this Chapter.
(a) This rule is intended to be read in conjunction with Chapter 22 and 42 C.F.R. Part 483, Subpart C.
(b) Terminology. Except as otherwise specified, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, Medicaid, and Medicare.
(a) 'Admission.' The act that allows an individual to officially enter a facility to receive nursing facility services.
'Admission' does not include a individual receiving respite care in a facility pursuant to the Long Term Care HCBS waiver or DD HCBS waivers.
(b) 'Alzheimer's disease.' A primary diagnosis of dementia, including Alzheimer's disease or a related disorder, as defined by the DSM.
(c) 'Applicant.' A person, including a patient, who has applied for Medicaid benefits and is a resident or is seeking admission to a facility.
(d) 'Appropriate placement.' The placement of an individual in a treatment setting when the individual's needs meet the minimum standards for admission to that treatment setting and the individual's needs for treatment do not exceed the level of services which the treatment setting is capable of providing.
(e) 'Categorical determination.' A PASRR determination of appropriate nursing facility placement made at the Level I screening stage by the Level I evaluator or by the Division. A categorical determination takes into account that certain diagnoses, levels of severity of illness, or need for a particular service clearly indicate that admission to or residence in a NF is normally needed, or that provision of specialized services is not normally needed.
(f) 'Chapter 1.' Chapter 1, Medicaid Fair Hearings, of the Wyoming Medicaid Rules.
(g) 'Chapter 3.' Chapter 3, Provider Participation, of the Wyoming Medicaid Rules.
(h) 'Chapter 5.' Chapter 5, Medicaid Long Term Care Facility Remedies/Terminations, of the Wyoming Medicaid Rules.
(i) 'Chapter 9.' Chapter 9, Hospital Services, of the Wyoming Medicaid Rules.
(j) 'Chapter 16.' Chapter 16, Medicaid Program Integrity, of the Wyoming Medicaid Rules.
(k) 'Chapter 22.' Chapter 22, Nursing Facility Evaluation of Medical Necessity, of the Wyoming Medicaid Rules.
(l) 'Classification in Mental Retardation.' The most recent Classification in Mental Retardation of the American Association on Mental Deficiency, which is incorporated by this reference. The book is published by the American Association on Mental Deficiency in Washington, D.C., and is available from the publisher.
(m) 'Convalescent care.' Medically prescribed nursing facility services provided to a person that is mentally ill or mentally retarded for up to 120 days after release from a hospital.
(n) 'Date of admission.' The date an individual enters a facility and begins receiving nursing facility services.
(o) 'DBH.' The Division of Behavioral Health of the Department, its agent, designee or successor.
(p) 'DDD.' The Division of Developmental Disabilities of the Department, its agent, designee or successor.
(q) 'Dementia.' An individual has dementia if the individual:
(i) Has a primary diagnosis of dementia as defined in the DSM, including Alzheimer's disease; or
(ii) Has a non-primary diagnosis of dementia, unless the individual's primary diagnosis is a major mental illness.
(r) 'Department.' The Wyoming Department of Health, its agent, designee or successor.
(s) 'DFS.' The Wyoming Department of Family Services, its agent, designee or successor.
(t) 'Division.' The Health Care Financing Division of the Department, its agent, designee or successor.
(u) 'DSM.' The most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, which is incorporated by this reference. The DSM is published by the American Psychiatric Association, Washington, D.C., and is available from the publisher.
(v) 'Emergency admission.' The admission of an individual with a mental illness or mental retardation that is for the protection of the individual, not to exceed seven (7) days.
(w) 'Excess payments.' Medicaid funds received by a provider to which the provider is not entitled, including Medicaid funds received for services furnished to a recipient in the absence of a timely Level I or Level II screening, as appropriate.
(x) 'Exempt hospital discharge.' An individual whose admission to a nursing facility meets the criteria set forth in 42 C.F.R. §483.106, which definition is incorporated by this reference.
(y) 'Facility.' A nursing facility that meets all of the requirements of state licensure and certification for participation in the Medicaid program. 'Facility' may include a distinct part of a hospital or institution which is designated to provide nursing facility services.
(z) 'HCFA.' The Health Care Financing Administration of the United States Department of Health and Human Services, its agent, designee, or successor.
(aa) 'Home or community-based waiver services (HCBS).' Services provided under a waiver from HCFA that are not otherwise available under the Wyoming Medicaid state plan. Such services enable the elderly, disabled, and chronically mentally ill persons, who would otherwise be placed in an institution, to live in the community. Section 1915(c) of the Social Security Act specifies the services that may be included as HCBS waiver services. 'HCBS waiver services' includes home and community-based services as specified in each applicable waiver.
(bb) 'Hospital.' A hospital as defined in Chapter 9, which definition is incorporated by this reference.
(cc) 'ICD.' The most recent edition of the International Classification of Diseases, which is incorporated by this reference. The ICD is published by HCFA and is available from the United States Government Printing Office, Washington, D.C., 20402.
(dd) 'IMD.' An institution for mental diseases as defined by 42 C.F.R. § 435.1009, which is incorporated by this reference.
(ee) 'IMD services.' Services that meet the standards of 42 C.F.R. Part 441 Subpart C, which is incorporated by this reference.
(ff) “Interfacility transfer.” The transfer of a patient from one facility to another, with or without an intervening hospital stay. An interfacility transfer is not a new admission for PASRR purposes.
(gg) “Medicaid.” Medical assistance and services provided pursuant to Title XIX of the Social Security Act and/or the Wyoming Medical Assistance and Services Act. “Medicaid” includes any successor or replacement program enacted by Congress or the Wyoming Legislature.
(hh) “Medically necessary.” Nursing facility or equivalent services are required because of an individual’s functional ability as determined by an evaluation of medical necessity pursuant to Chapter 22.
(ii) “Medicare.” The health insurance program for the blind, aged and disabled established pursuant to Title XVIII of the Social Security Act.
(jj) “Mentally retarded or mental retardation.” An individual with mild, moderate, severe or profound retardation as defined by the Classification in Mental Retardation, or a person with a related condition.
(kk) “New admission.” The admission of a patient that has not previously resided in any nursing facility. Readmissions or interfacility transfers are not new admissions.
(ll) “Nursing facility.” A nursing facility as defined by 42 U.S.C. § 1396r(a), which is incorporated by this reference.
(mm) “Nursing facility services.” Nursing facility services as defined in 42 U.S.C. § 1396d(f), which is incorporated by this reference.
(nn) “Organic brain syndrome.” Organic brain syndrome or a related condition as defined in the ICD.
(oo) “PAS.” Preadmission screening as set forth in Sections 6 and 7.
(pp) “PASRR.” Preadmission screening conducted pursuant to Chapter 19.
(qq) “Patient.” A resident of a facility.
(rr) “Person with a related condition.” An individual that has a severe, chronic disability that meets all of the conditions specified in 42 C.F.R. § 435.1009, which is incorporated by this reference.
(ss) “Physician.” A person licensed to practice medicine or osteopathy by the Wyoming State Board of Medical Examiners or a comparable agency in another state.
(tt) “Provider.” “Provider” as defined by Chapter 3, which definition is incorporated by this reference.
(uu) “Provisional admission.” An admission made pending further assessment in cases of delirium, where an accurate diagnosis cannot be made until the delirium clears. A provisional admission may not exceed fourteen days.
(vv) “Qualified mental health professional.” A mental health practitioner whose qualifications meet standards set by DBH, which are incorporated by this reference.
(ww) “Qualified staff member.” A member of a nursing facility’s or hospital’s staff that is qualified, by education, professional status or administrative authority, to discern the possibility or probability of mental illness or mental retardation, by reviewing medical records, observation of presenting evidence, or other sources.
(xx) “Provider agreement.” “Provider agreement” as defined by Chapter 3, which definition is incorporated by this reference.
(yy) “Readmission.” The admission of an individual that has previously been a resident of a facility. A readmission may occur after a hospitalization, the discharge from a facility or therapeutic home leave. A readmission is not considered a new admission for PASRR purposes.
“Recipient.” An individual who has been determined eligible for Medicaid.
(aaa) “Related condition.” “Related condition” as defined in 42 C.F.R. 435.1009, which definition is incorporated by this reference.
(bbb) “Respite care.” Nursing home care provided to an individual on a temporary basis for the relief of an in-home caregiver.
(ccc) “Serious mental illness.” An individual who meets the criteria for mental illness as defined in 42 C.F.R. § 483.102, which definition is incorporated by this reference. “Serious mental illness” does not include individuals experiencing temporary anxiety or depressive reactions to a terminal or chronic debilitating condition for which specialized services would not be appropriate, but for which mental health services of a lesser intensity than specialized services may be required based on physician evaluation and recommendation.
(ddd) “Severe medical condition.” An individual who is mentally ill or mentally retarded meets the criteria for “severe medical condition” if he or she is comatose, ventilator dependent, or functioning at the brain stem level, or has been diagnosed by a physician as having chronic obstructive pulmonary disease, severe Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, congestive heart failure, severe cardiovascular accident (CVA), quadriplegia, advanced multiple sclerosis, end stage renal disease, severe diabetic neuropathy or refractory anemia. The illness must result in a level of impairment so severe that the individual could not be expected to benefit from specialized services for mental illness or mental retardation.
(eee) “Specialized services.” “Specialized services” as defined in 42 C.F.R. § 483.120, which definition is incorporated by this reference.
(fff) “State mental health authority (SMHA).” The individual or entity within the DBH that has been designated as the state mental health authority, its agent, designee or successor.
(ggg) “State mental retardation authority (SMRA).” The individual or entity within the DDD that has been designated as the state mental retardation authority, its agent, designee or successor.
(hhh) “Terminally ill.” An individual that is mentally ill or mentally retarded and meets the criteria for terminal illness in 42 C.F.R. § 418.3, which definition is incorporated by this reference.
(iii) “Thirty-month rule.” The thirty-month rule as defined in 42 C.F.R. § 483.130, which definition is incorporated by this reference.
(a) Mentally ill individuals. Except as otherwise provided by this Section, a facility shall not admit any mentally ill individual unless:
(i) Prior to admission, the state mental health authority has determined, based on a physical and mental evaluation performed by a person or entity other than the state mental health authority, that the individual requires nursing facility services because of his or her physical and mental condition;
(ii) If the individual requires nursing facility services, the state mental health authority has determined whether the individual requires specialized services.
(b) Mentally retarded individuals or persons with related conditions. Except as otherwise provided by this Section, a facility shall not admit any patient who is mentally retarded or any person with a related condition unless:
(i) Prior to admission, the state mental retardation authority has determined that the individual requires nursing facility services because of his or her physical and mental condition; and
(ii) If the individual requires nursing facility services, the state mental retardation authority has determined whether the individual requires specialized services.
(c) Penalty for admission prior to screening. Any facility that admits any mentally ill or mentally retarded individual prior to a determination of appropriate placement shall be subject to:
(i) Denial of Medicaid payment for a Medicaid-eligible individual; and
(ii) Regardless of the individual’s payment source, the Division may impose any of the remedies specified in Chapter 5, using the procedures specified in Chapter 5. Chapter 5 is incorporated by this reference.
(a) Purpose. The Level I screening is performed by qualified staff of a nursing facility or hospital to determine whether an individual seeking admission to or residing in a facility needs further evaluation because of suspected mental illness, mental retardation or a related condition.
(b) Applicability. All individuals, regardless of payment source, who apply for admission to a facility on or after January 1, 1989, or who were patients in a facility on January 1, 1989, are subject to the requirements of this Section.
(c) Frequency of screening.
(i) Any individual who was a patient in a facility before January 1, 1989, must be screened on or before April 1, 1990.
(ii) Any individual seeking admission to a facility as a new admission on or after January 1, 1989, must be screened before admission.
(iii) If the screening does not result in a referral to Level II, the individual need not be screened again unless there is a significant change in the individual’s condition that indicates that a Level II screening is advisable.
(d) Screening. All screening shall be performed by a qualified staff member of the facility, using the following criteria:
(i) Mental illness. The screener shall consider whether:
(A) The individual is diagnosed with a serious mental illness by a physician or a qualified mental health professional; or
(B) The individual has a history of mental illness requiring treatment more intensive than outpatient treatment more than once in the past two years; or
(C) There is presenting evidence of a serious mental illness, including possible disturbances in orientation, affect or mood, that is not attributable to dementia or other medical diagnosis or treatment.
(ii) Mental retardation. The screener shall consider whether:
(A) A physician or qualified mental retardation professional has given the individual a primary or secondary diagnosis of mental retardation or a related condition; or
(B) The individual has a history of mental retardation or a related condition; or
(C) There are cognition or behavior deficits indicating mental retardation or a related condition; or
(D) The individual was referred by an agency that serves persons with mental retardation or related conditions, and the individual was eligible for that agency’s services.
(e) Recommendation. Upon completion of the Level I screening, the screener shall make a recommendation as to whether the individual should be referred for a Level II screening:
(i) If the recommendation is that a Level II screening is not necessary, the individual may be admitted to the facility; or
(ii) If the recommendation is that a Level II screening is necessary, the provisions of Section 7 apply.
(f) Notice. The nursing facility must provide written notice to the individual or resident, or his or her legal representative, if the individual is suspected of having mental illness or mental retardation and is being referred to the SMHA or SMRA for Level II screening. This notice is required for first-time Level II identifications only.
(g) Documentation requirements. The facility shall complete documentation in the format specified by the Division.
(a) Purpose. To determine whether an individual who is mentally ill or mentally retarded requires, because of the individual's physical and mental condition, the level of services provided by a nursing facility, and whether the individual requires specialized services.
(b) Applicability. All individuals who apply for admission to a facility on or after January 1, 1989, or who were patients in a facility on January 1, 1989, are subject to the requirements of this Section if the Level I screener or the Division recommends a Level II screening. No facility shall admit any individual for whom the Level I screening indicates a reason to refer the individual for a Level II screening until the Level II screening is completed and a determination of appropriate placement rendered.
(i) Pre-Admission Screening (PAS). New admissions whose Level I screening indicates the possibility of mental illness or mental retardation may not be admitted to the facility until the Level II screening is completed and a determination of appropriate placement is made.
(ii) Change in condition.
(A) If there has been a previous Level II and the resident has a significant improvement in physical functioning or an exacerbation of the mental illness, a new Level II must be requested promptly by the nursing facility. This will be done by completing a new Level I form and submitting it through established procedures. The facility must indicate on the Level I form that a new Level II is being requested because of an improvement in physical condition or an exacerbation of the mental illness.
(B) If a resident receives a new diagnosis of mental illness, a new Level I must be completed indicating that a new diagnosis of a mental illness has occurred. The Level I must be submitted through the established procedures.
(d) Failure to timely comply with PAS requirements.
(i) PAS. Medicaid reimbursement shall be disallowed for nursing facility services furnished to a recipient before the Level II screening is completed and a determination of appropriate placement in a nursing facility is made.
(ii) Non-Medicaid individuals. For failure to timely comply with PAS requirements for non-Medicaid eligible individuals, the Division may impose any of the remedies specified in Chapter 5 using the procedures specified in Chapter 5.
(e) Categorical determinations. The Level I evaluator may determine that an individual with mental illness or mental retardation meets the criteria for a categorical determination and does not need to be referred to the SMHA or SMRA for an individual Level II review and determination. An individual with mental illness or mental retardation who meets the criteria for any category in this section shall be deemed appropriate for nursing home placement.
(i) Terminal illness. A diagnosis of terminal illness constitutes a Level II determination of appropriate placement, specialized services not required.
(ii) Severe medical condition. A diagnosis of severe medical condition constitutes a Level II determination of appropriate placement. The individual must meet both of the conditions below:
(A) The individual is mentally ill or mentally retarded and meets the criteria for “severe medical condition”.
(B) The illness results in a level of impairment so severe that the individual could not be expected to benefit from specialized services for mental illness or mental retardation.
(iii) Convalescent care. The individual requires a nursing facility stay of no more than 120 days. After that time, the facility must refer the individual for a Level II. The individual is mentally ill or mentally retarded and has an acute physical illness which:
(A) Required hospitalization; and
(B) Does not meet the criteria for an exempt hospital discharge as defined in 42 C.F.R. § 483.106.
(iv) Provisional placement. The individual requires a nursing facility stay of no more than 14 days. After that time, the facility must refer the individual for a Level II. The individual is mentally ill or mentally retarded and requires admission for:
(A) Delirium, where an accurate diagnosis cannot be made until the delirium clears; or
(B) Respite care.
(v) Emergency admissions. The individual is mentally ill or mentally retarded and requires a nursing facility stay of no more than 7 days for his or her protection. After that time, the facility must refer the individual for a Level II.
(f) Criteria for Level II screening.
(i) Determination of medical necessity. Each patient referred for a Level II screening, regardless of payment source, must be evaluated for medical necessity pursuant to Chapter 22.
(ii) Level II screening shall be performed using the minimum criteria specified by HCFA in §§ 4251 through 4253 of the State Medicaid Manual (“SMM”), as appropriate for a specific individual. Sections 4251 through 4253 are incorporated by this reference. The SMM is published by HCFA and is available from HCFA or the Division.
(iii) Determination of appropriate placement. The SMHA or SMRA (as applicable) shall review the mental and physical evaluations and the determinations of medical necessity and determine whether, based on the individual’s physical and mental condition, the individual requires the level of services provided by the NF into which the individual seeks admission.
(iv) Determination of need for specialized services.
(A) Mentally ill persons. The need for specialized services for mentally ill persons shall be determined using the procedures and protocols of the SMHA, which are incorporated by this reference. The procedures and protocols of the SMHA are available from the SMHA or the Division.
(B) Mentally retarded persons. The need for specialized services for mentally retarded persons shall be determined using the procedures and protocols of the SMRA, which are incorporated by this reference. The procedures and protocols of the SMRA are available from the SMRA or the Division.
(g) Results of Level II screening. The Level II screening will result in a determination of the appropriateness of nursing facility placement and the need for specialized services. The following outcomes are possible.
(i) Individual requires nursing facility services, but does not require specialized services.
(A) Nursing facility placement is appropriate; and
(B) Mental health services of a lesser intensity than specialized services may be recommended.
(ii) Individual requires nursing facility services and specialized services provided in the nursing facility.
(A) Nursing facility placement is appropriate; and (B) The State must arrange for provision of specialized services.
(D) Persons that do not require nursing facility services but require specialized services and choose to remain in the nursing facility under the thirty-month rule are deemed to require nursing facility services.
(iii) Individual does not require nursing facility services or specialized services.
(A) Nursing facility placement is not appropriate or authorized; admission is denied; or
(B) If resident is already admitted, facility must arrange for orderly discharge, including preparation and orientation of resident for discharge.
(iv) Individual does not require nursing facility services, but does require specialized services that cannot be provided in the facility.
(A) Nursing facility placement is not appropriate or authorized; admission is denied; or
(B) If resident is already admitted, facility must arrange for orderly discharge, including preparation and orientation of resident for discharge.
(v) No evidence of serious mental illness and no evidence of mental retardation. Nursing facility placement is authorized;
(vi) Individual has a primary or secondary diagnosis of dementia without an accompanying condition of mental retardation (if the individual has a diagnosis of mental retardation with dementia, placement is authorized. Nursing facility placement is authorized;
(vii) Individual is categorically appropriate due to terminal illness or severe medical condition pursuant to subsection 6(e). Nursing facility placement is authorized;
(viii) Evaluation not completed due to death or discharge.
(A) PAS not complete. Medicaid reimbursement for nursing facility services will not be authorized;
(B) ARR not complete. Medicaid reimbursement will be authorized.
(h) Notice of Level II determination.
(i) Notice to facility. The Division shall notify the facility, in writing, of the results of each Level II determination; and
(ii) Notice to individual. The Division shall notify the individual, in writing, of a Level II determination that nursing facility placement is not appropriate. The individual may request a reconsideration regarding the decision that such placement is not appropriate pursuant to Section 10.
(i) If a resident who has had a Level II within one year is transferred from one nursing facility to another, the transferring facility must copy the Level II documentation and send it with the resident as part of the transfer documentation. The admitting facility does not need to complete a Level I or II screening if the recipient's Level II was completed less than one year before the transfer.
(a) Completion of screening. No facility shall receive Medicaid reimbursement for nursing facility services furnished to a recipient until:
(i) The completion of the Level I screening which indicates that there is no need for Level II screening; or, if the Level I screening indicates the need for Level II screening, the completion of the Level II screening and a determination that nursing facility services are appropriate; and
(ii) The completion of the evaluation of medical necessity pursuant to Chapter 22 which indicates that nursing facility services are medically necessary.
(b) Retroactive payments.
(i) For recipients that do not require Level II screening, Medicaid reimbursement shall commence upon receipt by the Department of the results of the Level I screening indicating that there is no need for a Level II screening. Reimbursement shall be retroactive to the date of the completion of the Level I screening, provided there was an evaluation of medical necessity pursuant to Chapter 22.
(ii) For recipients that require Level II screening, Medicaid reimbursement shall commence upon the completion of the Level II screening which indicates that nursing facility services are appropriate, except as specified in Section 7. Reimbursement shall be retroactive to the date of the completion of the Level II screening, provided there was an evaluation of medical necessity pursuant to Chapter 22. Payments for residents permitted to continue to reside in a facility pursuant to the thirty-month rule are subject to the provisions of this paragraph except that such payments shall be contingent upon the completion of a Level II screening, regardless of whether the screening indicates that nursing facility services are appropriate.
Section 9. Recovery of excess payments. The Department shall recover excess payments pursuant to the provisions of Chapter 3, which are incorporated by this reference.
(a) Request for reconsideration.
(i) A provider may request that the Department reconsider a decision to deny payment or to recover excess payments. A provider may not request that the Department reconsider a Level II determination of appropriate placement made pursuant to this Chapter. The request for reconsideration must be mailed to the Department by certified mail, return receipt requested within twenty days of the date the facility receives notice of the denial of payment or notice to recover excess payments. The request must state with specificity the reasons for the request. Failure to provide such a statement shall result in the dismissal of the request with prejudice.
(ii) An applicant or recipient may request that the Department reconsider an adverse Level II determination of appropriate placement made pursuant to this Chapter. Such request must be mailed to the Department by certified mail, return receipt requested within twenty days of the date the individual receives notice of the Level II determination.
(b) Reconsideration. The Department shall review the decision and send written notice by certified mail, return receipt requested, to the party requesting reconsideration of its final decision within forty-five days after receipt of the request for reconsideration or the receipt of any additional information requested pursuant to (c), whichever is later.
(c) Request for additional information. The Department may request additional information from the provider or recipient as part of the reconsideration process. Such a request shall be made in writing by certified mail, return receipt requested. The provider or recipient must provide the requested information within thirty days after the date of the request. Failure to provide the requested information shall result in the dismissal of the request with prejudice.
(d) Reconsideration shall be limited to whether the Department has complied with the provisions of this Chapter.
(e) Informal resolution. The party requesting reconsideration or the Department may request an informal meeting before the final decision on reconsideration to determine whether the matter may be resolved. The substance of the discussions and/or settlement offers made pursuant to an attempt at informal resolution shall not be admissible as part a subsequent administrative hearing or judicial proceeding.
(f) Failure to request reconsideration.
(i) A provider that fails to request reconsideration pursuant to this section regarding a decision to deny payment or to recover excess payments may not subsequently request an administrative hearing regarding pursuant to Chapter I.
(ii) A recipient or applicant may elect not to request reconsideration and may request an administrative hearing pursuant to Chapter I. A recipient or applicant that requests reconsideration may request an administrative hearing at any time during reconsideration or within thirty days after the date the notice of the adverse action is mailed. Such request for hearing shall be pursuant to Chapter I.
(g) Confidentiality of settlement agreements. If the Division and a provider enter into a settlement agreement as part of a reconsideration or an administrative hearing, such agreement shall be confidential, except as otherwise required by law. A breach of confidentiality by the provider shall, at the Division's option, result in the settlement agreement becoming null and void.
Section 11. Administrative hearing.
(a) Subject to Section 10(f), a provider may request an administrative hearing regarding the final decision pursuant to Chapter 1 of these rules by mailing by certified mail, return receipt requested or personally delivering a request for hearing to the Department within twenty days of the date the provider receives notice of the final decision.
(b) An applicant or recipient may request an administrative hearing pursuant to Chapter 1 regarding the Level II determination of appropriate placement. Such a request for hearing shall be made by mailing by certified mail, return receipt requested or personally delivering a request for hearing to the Department within thirty days of the date of the notice of the adverse action.
(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more less important than any other provision.
(b) The text of this Chapter shall control the titles of its various provisions.
Section 13. Superseding effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including Provider Manuals and Provider Bulletins, which are inconsistent with this Chapter.
Section 14. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in full force and effect.