New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.32 - Administrative rate appeals

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Administrative rate appeals of rates of payment issued pursuant to this Subpart
					 must be submitted to the department in writing within 120 days of the date such
					 rates are issued by the department to the facility. Such rate appeals must set
					 forth in detail the basis for such appeal and be accompanied by any relevant
					 documentation. Thereafter the department shall respond to such rate appeals in
					 writing and shall either affirm the original rates, revise such rates or
					 request additional information. A failure to respond to the department's
					 request for additional information within 30 days shall be deemed to constitute
					 the withdrawal, with prejudice, of the facility's rate appeal, provided,
					 however, that the department may extend that time period upon a request by the
					 facility and for good cause shown. Upon its receipt of the requested additional
					 information the department shall issue a written determination of such rate
					 appeal.
(b) The department's
					 written determination of a facility's rate appeal shall be deemed final unless
					 the facility submits a written request for further consideration of the rate
					 appeal within 30 days of the date the department issued such written
					 determination, provided, however, that if such written determination advises
					 the facility that its rate appeal is being denied on the ground that the appeal
					 constitutes a challenge to the rate-setting methodology set forth in this
					 Subpart, such denial shall be deemed to be the department's final
					 administrative determination with regard to such appeal and there shall be no
					 further administrative review available. The department shall otherwise respond
					 in writing to such further appeal and either affirm or revise its original rate
					 appeal determination and this response by the department shall be deemed its
					 final administrative determination with regard to such rate appeal.
(c) Rate appeals which are rejected or
					 precluded on the grounds of being untimely may be considered in connection with
					 subsequent audits conducted pursuant to section
					 86-1.4  of this
					 Subpart.
(d) The department shall
					 consider only those rate appeals that reflect one or more of the following
					 bases:
(1) mathematical or clerical errors in
					 the financial and/or statistical data originally submitted by the medical
					 facility, including information reported to the New York State Statewide
					 Planning and Research Cooperate System (SPARCS) in accordance with section
					 400.18 
					 of this Title, or mathematical or clerical errors made by the department.
					 Revised data submitted by a facility must meet the same certification
					 requirements as the original data and the department may require verification
					 of revised SPARCS data by an independent review agent at the cost of the
					 facility; and
(2) any errors
					 regarding a medical facility's capital cost reimbursement;
(3)
(i)
					 direct medical education (DME) and indirect medical education (IME) costs, as
					 defined in sections
					 86-1.15(f)(1) and
					 (f)(2)  of this Subpart, for hospitals where
					 the teaching status has changed from non-teaching to teaching;
(ii) the effective date of the initial rate
					 adjustment shall be the later of the first of the month following 60 days from
					 the department's receipt of the written notification with documentation
					 requesting a rate adjustment or July 1st of the program year.