N.D. Admin Code 75-02-09-18 - Reconsiderations and appeals

Current through Supplement No. 383, January, 2022

1. Reconsiderations.
a. A facility dissatisfied with the final rate established must request a reconsideration of the final rate before a formal appeal may be made. Any requests for reconsideration must be filed with the department's medical services division within thirty days of the date of the rate notification.
b. A request for reconsideration must include:
(1) A statement of each disputed item and the reason or basis for the dispute;
(2) The dollar amount of each item that is disputed; and
(3) The statute or rule upon which the facility is relying for each disputed item.
c. The department may request additional documentation or information relating to a disputed item. If additional documentation is not provided within fourteen days of the department's request, the department shall make its determination based on the information and documentation available as of the fourteenth day following the date the department requested additional documentation.
d. The department's medical services division shall make a determination regarding the reconsideration within forty-five days of receiving the reconsideration filing and any requested documentation.
2. Appeals.
a. A facility dissatisfied with the final rate established may appeal upon completion of the reconsideration process as provided in subsection 1. An appeal must be filed with the department within thirty days of the date on the written notice of the determination by the medical services division with respect to a request for reconsideration.
b. An appeal under this section is timely perfected only if accompanied by written documents, including:
(1) A copy of the letter received from the department's medical services division advising of that division's decision on the request for reconsideration;
(2) A statement of each disputed item and the reason or basis for the dispute;
(3) A computation and the dollar amount which reflects the appealing party's claim as to the correct computation and dollar amount for each disputed item;
(4) The authority in statute or rule upon which the appealing party relies for each disputed item; and
(5) The name, address, and telephone number of the person upon whom all notices will be served regarding the appeal.

Notes

N.D. Admin Code 75-02-09-18
Effective May 1, 1994; amended effective October 1, 2011.

General Authority: NDCC 50-24.1-04

Law Implemented: 42 USC 1396 a(a)(30)(A)

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