Kan. Admin. Regs. § 129-9-6

Current through Register Vol. 44, No. 2, January 9, 2025

Section 129-9-6 - Provider reconsideration

(a) Any provider may submit a request for a reconsideration to the MCE if the basis of the request is an action by an MCE as defined in 129-9-1(b)(1)(A) and (b)(1)(B).

(b) Any provider may submit either a reconsideration request or an appeal request following receipt of the notice of action. The MCE may require that the provider submit the reconsideration in writing. Each written reconsideration delivered by the postal service or submitted by facsimile to the MCE shall be date-stamped when received by the MCE as proof of receipt. The MCE shall use the date of receipt to determine timeliness of the request.

(c) Each MCE shall provide the provider with the opportunity to submit a request for a reconsideration following receipt of the MCE's notice of action. For each reconsideration under this article of the division's regulations to be considered timely pursuant to K.S.A. 39-709h(e)(4) and amendments thereto, the request shall be received by the MCE within 120 days of the date of the notice of action. Three days shall be added to the 120-day response period if the notice is served by U.S. mail or electronic means.

(d) The MCE shall not be required to send an acknowledgement letter after receipt of the reconsideration request.

(e) The MCE shall not be required to resolve the reconsideration request within a defined period of time. The MCE shall send notice of reconsideration resolution no later than five business days of the date of reconsideration resolution as specified in the state's managed care contract. The notice of reconsideration resolution shall meet the requirements in 129-9-4.

(f) The reconsideration process shall be optional, but the provider shall complete the MCE's appeal process before requesting a state fair hearing.

(g) The provider's right to appeal shall be preserved throughout the reconsideration process. The provider may terminate the reconsideration process and submit an appeal request within 60 days of the date of the notice of action. Three days shall be added to the 60-day response period if the notice is served by U.S. mail or electronic means.

(h) If the provider terminates the reconsideration process more than 63 days after the date of the notice of action, the provider shall wait to receive the MCE's notice of reconsideration resolution before submitting an appeal or the appeal will be untimely.

(i) The provider's right to request a reconsideration shall not be limited or interfered with by the secretary or the MCE.

(j) The MCE shall cooperate with the state, the state's fiscal agent, or representatives of either to resolve all provider reconsiderations. Cooperation may include providing internal provider reconsideration information to the state.

Kan. Admin. Regs. § 129-9-6

Authorized by and implementing K.S.A. 651,254 and 75-7403; adopted by Kansas Register Volume 43, No. 50; effective 12/27/2024.