Section 17-1740.1-12 - Rate reconsideration(a) Providers shall have the right to request a rate reconsideration if extraordinary circumstances beyond the control of the provider occur after December 31, 2001 and PPS payments are insufficient due to these extraordinary circumstances. Extraordinary circumstances include, but are not limited to acts of God, changes in life and safety code requirements, and changes in licensure law, and rules or regulations. Mere inflation of cost, absent extraordinary circumstances, shall not be grounds for rate reconsideration. If a provider's PPS rate is sufficient to cover its overall costs including those associated with the extraordinary circumstances, then a rate reconsideration is not warranted.(b) The department will accept a request for rate reconsideration for a prospective payment year at any time during that prospective payment year or within thirty days following the end of that prospective payment year.(c) Requests for rate reconsiderations shall be submitted in writing to the department and shall set forth the reasons for the requests. Each request shall be accompanied by sufficient documentation to enable the department to act upon the request. Documentation shall include the data necessary to demonstrate that the circumstances for which reconsideration is requested meet the requirements noted above. Documentation shall include the following: (1) A presentation of data to demonstrate reasons for the provider's request for a rate reconsideration.(2) The rate reconsideration request must be accompanied by documentation showing the cost implications. The cost impact must be material and significant ($200,000 or one per cent of a facility's total costs, whichever is less). Documentation must be sufficient to compute an adjustment amount to the PPS rate for the purpose of determining a managed care supplemental payment amount if necessary.(d) Each rate reconsideration request will be applicable only for the remainder of the PPS rate year. If the reconsideration request is granted, it will be effective no earlier than the first date of the PPS rate year during which the reconsideration request is received. If a provider believes that its experience justifies continuation of the reconsidered rate in subsequent years, then it shall submit information to update the documentation provided in the prior request. A request must be submitted for each affected year.(e) Amounts granted for rate reconsideration requests will be paid as lump-sum amounts for those years and not as revised PPS rates.(f) The provider shall be notified of the department's decision in writing within ninety calendar days from the date all necessary verification and documentation have been provided.(g) A provider may appeal the department's (Formatted: Bullets and Numbering) decision on the rate reconsideration if the Medicaid impact is $10,000 or more. The appeal shall be filed in accordance with the procedural requirements of chapter 17-1736.Haw. Code R. § 17-1740.1-12
[Eff 11/20/03] (Auth: HRS § 346-14, 42 C.F.R. §431.10 ) (Imp: Pub. L. No. 106-554 )