N.Y. Comp. Codes R. & Regs. tit. 14 § 503.9

Current through Register Vol. 46, No. 25, June 18, 2024

Section 503.9 - Hearing procedures: revision of certified rate of payment pursuant to audit findings

(a) This section shall apply to hearings held pursuant to any law or regulation giving a facility licensed by the Office of Mental Health the right to request a hearing to appeal an agency audit finding which results in a proposed revision of a certified rate of payment. This section does not apply to hearings pursuant to audits conducted by the Department of Social Services, which shall be conducted in accordance with applicable regulations of the State Department of Social Services. Where a conflict exists between this section and any other section of this Part, the provisions of this section shall be controlling.

(b) If the commissioner affirms some or all of the Office of Mental Health's proposed revision of a certified rate of payment upon administrative review of the audit findings, the provider shall have a right to a hearing pursuant to this Part.

(c) The proposed revision of a certified rate of payment resulting from an audit finding, as adjusted in accordance with the determination after administrative review, shall be final unless, within 30 days of service of the determination, the provider requests a hearing. The notice of the final audit findings, as served on the provider, shall be deemed to be the notice of proposed action under section 503.4(a) of this Part.

(d) A request for a hearing pursuant to this section shall be sent to the commissioner by registered or certified mail and shall contain a statement of the factual issues in dispute.

(e) Upon receipt of a request for a hearing, the commissioner shall determine whether a hearable factual issue is in dispute. If it is determined that there is no factual issue in dispute, the request for a hearing shall be denied; no administrative appeal shall be available from this determination. When it is determined that there is a factual issue in dispute, the commissioner shall order an administrative hearing to be held.

(f) The burden of proof shall be on the provider to prove by clear and convincing evidence that findings of fact on which the determination was based are incorrect.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 503.9