Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-26 - Administrative reconsideration; appeal

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  4-21.5-3; IC
				  12-13-7-3
Sec. 26.
(a) The
				office shall notify each provider of the provider's rate and allowable cost
				determinations after they have been computed. If the provider disagrees with
				the rate or allowable cost determinations, the provider may request an
				administrative reconsideration by the office. Such reconsideration request
				shall be in writing and shall contain specific issues to be reconsidered and
				the rationale for the provider's position. The provider must request
				administrative reconsideration before filing an appeal. Only issues raised by
				the provider during the administrative reconsideration may be subsequently
				raised in an appeal. The request shall be signed by the provider or the
				authorized representative of the provider and must be received by the office
				not later than forty-five (45) days after release of the rate or allowable cost
				determinations as computed by the office. Upon receipt of the request for
				reconsideration, the office shall evaluate the data. After review, the office
				may amend the rate, amend the challenged procedure or allowable cost
				determination, or affirm the original decision. The office shall thereafter
				notify the provider of its final decision in writing, not later than forty-five
				(45) days from the office's receipt of the request for reconsideration. In the
				event that a timely response is not made by the office to the provider's
				reconsideration request, the request shall be deemed denied and the provider
				may pursue its administrative remedies as set out in subsection (c).
(b) If the provider disagrees with the
				preliminary recalculated Medicaid rate or allowable cost redetermination
				resulting from a financial audit adjustment or reportable condition the
				provider may request an administrative reconsideration from the office. Such
				reconsideration request shall be in writing and shall contain specific issues
				to be considered and the rationale for the provider's position. The provider
				must request administrative reconsideration before filing an appeal. Only
				issues raised by the provider during the administrative reconsideration may be
				subsequently raised in an appeal. The request shall be signed by the provider
				or the authorized representative of the provider and must be received by the
				office not later than forty-five (45) days after release of the preliminary
				recalculated Medicaid rate or allowable cost determinations as computed by the
				office. Upon receipt of the request for reconsideration, the office shall
				evaluate the data. After review, the office may amend the audit adjustment or
				reportable condition or affirm the original adjustment or reportable condition.
				The office shall thereafter notify the provider of its final decision in
				writing not later than forty-five (45) days from the office's receipt of the
				request for reconsideration. In the event that a timely response is not made by
				the office to the provider's reconsideration request, the request shall be
				deemed denied and the provider may pursue its administrative remedies under
				subsection (c).
(c) After
				completion of the reconsideration procedure under subsection (a) or (b), the
				provider may initiate an appeal under IC
				4-21.5-3. The request for an appeal
				must be signed by the provider.
(d)
				The office may take action to implement Medicaid rates without awaiting the
				outcome of the administrative process, in accordance with section 1(d) of this
				rule.