Opinion ID: 4514777
Heading Depth: 3
Heading Rank: 3

Heading: Attachment 4.19-A, Section VI, Subsection K.1

Text: ¶61. The DOM also relies on Section IV, subsection K.1, which reads, The prospectively determined individual hospital’s rate may be adjusted under certain circumstances, which are: 1. Discovery of administrative errors on the part of [the DOM] or the facilities which may result in erroneous payments, as determined by [the DOM] . . . . ¶62. CMMC discovered mistakes made that resulted in erroneous payments. The phrase “as determined by [the DOM]” authorizes the DOM to correct these mistakes. This provision makes no sense if the DOM is bound by mistakes in the Medicare NPR. 28 ¶63. Section IV, subsection K, does not extinguish a hospital’s right to appeal errors made in those adjustments or errors in the calculation of the revised rate. It does not create an exception to the DOM’s authority to correct mistakes merely because the incorrect data comes from the Medicare NPR. As discussed below, under Section VI of Attachment 4.19-A, if the hospital disagrees with that adjustment or with the calculation, it may file an appeal with the DOM. This is exactly what CMMC did and is clearly authorized by the Plan.