D.C. Mun. Regs. tit. 29, r. 29-4908

Current through Register 71, No. 45, November 7, 2024

Rule 29-4908 - ADJUSTMENT(S) TO THE PAYMENT RATE

4908.1

After completion of an audit of CFSA's reported costs, MAA shall provide CFSA with a written notice of its determination of any adjustment to the payment rate. The notice shall include the following:

(a) A description of the rate adjustment, including the original payment rate and the revised payment rate;

(b) The effective date of the change in the payment rate;

(c) The amount of money due to or from MAA attributable to the change in the payment rate;

(d) A summary of all audit adjustments made to CFSA's reported costs, including an explanation, by appropriate reference to law, rules, or the program manual, of the reason in support of the adjustment; and

(e) A statement informing CFSA of the right to request an administrative review within sixty (60) days of the date of the determination.

4908.2

CFSA shall have sixty days from the date of the determination issued pursuant to subsection 4908.1 to submit a written request for administrative review if it disagrees with any audit adjustment or payment rate calculation. The request for administrative review shall be submitted to the Financial Manager, Audit and Finance Office, Medical Assistance Administration, Department of Health.

4908.3

The written request for administrative review shall include a specific description of the audit adjustment or payment rate calculation to be reviewed, the reason for the review, the relief requested, and any documentation in support of the relief requested.

4908.4

MAA shall mail a written determination relative to the administrative review not later than one hundred and twenty (120) days from the date of the written request for administrative review under 4908.1.

4908.5

Within forty five (45) days of receipt of the MAA's written determination, CFSA may appeal the written determination by filing a written notice of appeal with the Board of Appeals and Review.

4908.6

Filing an appeal shall not stay any action to recover any overpayment.

D.C. Mun. Regs. tit. 29, r. 29-4908

Emergency Rulemaking published at 48 DCR 8872 (September 21, 2001) [EXPIRED]; as amended by Final Rulemaking published at 49 DCR 247 (January 11, 2002)