Title: Section 86-8.5 - Administrative rate appeals

Section 86-8.5 Administrative rate appeals

(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 published 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 the facility’s request for further consideration 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.