Section 29-4502. PROSPECTIVE PAYMENT SYSTEM

 

4502.1After completion of the audit of the FQHC's reported costs for FYs 1999 and 2000, MAA shall provide each FQHC a written notice of its determination of any adjustment to the payment rate. The notice shall include the following:

 

(a)A description of the rate adjustment;

 

(b)The amount of money due to or from MAA attributable to the change in the payment rate;

 

(c)A summary of all audit adjustments made to the FQHC's reported costs, including an explanation, by appropriate reference to the law, rules, or program manual, of the reason in support of the adjustment; and

 

(d)A statement informing the FQHC of the right to request an administrative review within sixty (60) days of the date of the determination.

 

4502.2A FQHC shall have sixty days from the date of the determination issued pursuant to section 4502.1 to submit a written request for administrative review, if it disagrees with any audit adjustment or payment rate calculation. The request for administrative review shall be submitted to the Financial Manager, Audit and Finance, Department of Health, Medical Assistance Administration.

 

4502.3The written request for administrative review shall include a specific description of the audit adjustment or payment rate calculation to be reviewed, the reason for the review, the relief requested, and any other documentation in support of the relief requested.

 

4502.4MAA shall mail a written determination relative to the administrative review no later than one hundred and twenty (120) days from the date of the written request for administrative review under § 4502.2.

 

4502.5Within forty- five (45) days of receipt of MAA's written determination, a FQHC may appeal the written determination by filing a written notice of appeal with the Board of Appeals and Review.

 

4502.6Filing an appeal shall not stay any action to recover any overpayment.

 

source

Final Rulemaking published at 49 DCR 7724 (August 9, 2002).