N.Y. Comp. Codes R. & Regs. tit. 9 § 9850.10

Current through Register Vol. 46, No. 36, September 4, 2024

Section 9850.10 - Conduct of hearings; rights of provider

(a) The hearing officer shall preside over the hearing, make all procedural rulings, and make a statement on the record describing the nature of the proceedings, the issues, and the manner in which the hearing will be conducted.

(b) The issues and documentation presented at the hearing shall be limited to issues relating to determinations made in the final audit report. A provider may not raise issues regarding the methodolgy used to determine the rate of payment or dispensing fee.

(c) The rules of evidence observed by a court of law need not apply.

(d) Computer-generated documents prepared by the contractor or its agent to show the nature and amount of payments made under the program shall be presumed, in the absence of evidence to the contrary, to constitute an accurate reflection of the contractor's records as to the amount and type of payment made to a provider as well as the basis for such payment.

(e) An extrapolation based upon a contractor audit utilizing a valid statistical sampling method shall be presumed, in the absence of evidence to the contrary, to be accurate.

(f) An audit report of the contractor shall be presumed to be correct and the burden of proof shall be on the provider to show by substantial evidence that any item of such report is incorrect.

(g) All testimony shall be given under oath or affirmation administered by the hearing officer.

(h) The provider shall be entitled to be represented, to have witnesses give testimony and to otherwise present relevant and material evidence on the provider's behalf, to cross-examine witnesses and to examine any document or other item offered into evidence.

(i) A verbatim record of the hearing will be maintained.

(j) In the discretion of the hearing officer, the hearing may be adjourned for good cause upon the request of either party or upon the hearing officer's own motion.

(k) The hearing shall be conducted in conformity with procedural requirements of section 12-a of the Public Health Law and the State Administrative Procedure Act.

(l) At the conclusion of the hearing, the hearing officer may direct the provider and the contractor to submit memoranda on any legal issues relevant to the proceeding within time frames established by the hearing officer. The hearing officer may also direct the parties to submit proposed findings of fact.

N.Y. Comp. Codes R. & Regs. Tit. 9 § 9850.10