Section 51016 - Definitions(a) The following definitions shall be used throughout this article unless otherwise noted. (1) Audits or Examination Report. "Audit or examination report" means a document that presents the final audit or examination findings and is formally issued to the provider by the Department upon the completion of the audit or examination.(2) Completed Audit or Examination. "Completed audit or examination" means an audit or examination for which an audit or examination report has been issued.(3) "Date of mailing" means the date postmarked on the envelope if postage was prepaid and the envelope was properly addressed.(4) Demand for Repayment. "Demand for repayment" means a written notice issued to the provider by the Department that identifies the amount of the overpayment, determined by an audit or examination, that must be repaid. The notice may be made through the issuance of a statement of accountability, statement of account status, letter, or any combination of the foregoing.(5) Duplicate. "Duplicate" means a counterpart or facsimile copy of the original produced by the same impression or from the same matrix as the original or by some technique of accurate reproduction.(6) "Exit conference" means an informal meeting, between the provider and those Department representatives responsible for the audit or examination, at which the preliminary findings of the audit or examination are discussed.(7) Formal Hearing. "Formal hearing" means an administrative hearing conducted by a hearing officer pursuant to Section 14171(b), Welfare and Institutions Code, and the provisions of this article.(8) Hearing Auditor. "Hearing auditor" means an individual designated to conduct the informal level of review.(9) Hearing Officer. "Hearing officer" means a hearing officer appointed by the Director pursuant to Section 14171(b), Welfare and Institutions Code.(10) Informal Conference. "Informal conference" means a proceeding conducted in person or by telephone, for the purpose of scheduling the informal level of review and formal hearing; exchanging documents; and resolving other preliminary matters.(11) Informal Level of Review. "Informal level of review" means an informal hearing for institutional providers and a pretrial conference for non-institutional providers, held by a hearing officer or hearing auditor prior to a formal hearing to clarify or resolve facts and issues in dispute.(12) Party. "Party" means the provider, the Department and any person, other than a hearing officer, allowed to appear in the proceedings.(13) Institutional Provider. "Institutional provider" means any of the following: (A) Any individual, entity or organization of a type required to be licensed pursuant to either Chapter 1 (commencing with Section 1200) or Chapter 2 (commencing with Section 1250) of Division 2, Health and Safety Code, or exempt from licensure pursuant to Section 1206(b) through (l) Health and Safety Code, or Section 1254 Health and Safety Code which provides services or supplies under the Medi-Cal program, and is subject to audit by the Department.(B) Any individual, entity, or organization of a type required to file a cost report or cost information with the Department.(14) Non-institutional Provider. "Non-institutional provider" means any individual, entity, or organization other than those defined in subsection (13) who provides services or supplies under the Medi-Cal program, and who is subject to audit by the Department.(15) File. "File" means delivery of a pleading or other paper to, and its date stamping by, the Office of Administrative Hearings and Appeals, Office of Legal Services, Department of Health Services.(16) Serve. "Serve" means the delivery of a pleading or other paper on a party in the manner provided by Government Code Section 11505(c).Cal. Code Regs. Tit. 22, § 51016
1. Repealer of Section 51016 and new Article 1.5 (Sections 51016-51043) filed 3-2-76; designated effective 4-1-76 (Register 76, No. 10). For prior history, see Register 72, No. 11, and Register 75, No. 23.
2. Repealer of Article 1.5 (Sections 51016-51043) and new Article 1.5 (Sections 51016-51047) filed 5-8-80; effective thirtieth day thereafter (Register 80, No. 19).
3. Amendment filed 10-11-84; effective upon filing pursuant to Government Code Section 11346.2(d) (Register 84, No. 41).
4. Amendment filed 9-17-85; effective thirtieth day thereafter (Register 85, No. 38). Note: Authority cited: Sections 14105, 14124.5 and 14171, Welfare and Institutions Code. Reference: Sections 14171 and 14172.5, Welfare and Institutions Code.
1. Repealer of Section 51016 and new Article 1.5 (Sections 51016-51043) filed 3-2-76; designated effective 4-1-76 (Register 76, No. 10). For prior history, see Register 72, No. 11, and Register 75, No. 23.
2. Repealer of Article 1.5 (Sections 51016-51043) and new Article 1.5 (Sections 51016-51047) filed 5-8-80; effective thirtieth day thereafter (Register 80, No. 19).
3. Amendment filed 10-11-84; effective upon filing pursuant to Government Code Section 11346.2(d) (Register 84, No. 41).
4. Amendment filed 9-17-85; effective thirtieth day thereafter (Register 85, No. 38).