Reviews

Section 145 Section 145.90  Reviews a)         Upon notification that it has been determined to be a Class II IMD, either as the result of a subsequent review pursuant to Section 145.50 or a redetermination review pursuant to Section 145.60(c), a facility may request a review of the Department's determination.  Such a request must be submitted in writing and received by the Department within 30 days after the date of the Department's notice to the facility that it has been determined to be an IMD.  Such a request shall include a clear explanation and supporting documentation of the facility's basis for considering the Department's determination that it is an IMD to be in error. Department review shall be limited to the Department's: 1)         calculation of the percentage of persons whose mental disease is the reason for being in the facility; and 2)         determination of those residents who are counted in arriving at the number of persons whose mental disease is the reason for being in the facility and the number of residents who have a physical or medical reason for being in the facility. b)         The Department shall complete its review and issue a final determination of a facility's request for review unless the Department in the course of its review determines that an on-site visit is needed.  Upon the request of the Department, a facility may submit further documentation to the Department in support of its request for review during the course of the Department's review.  Department review shall not delay implementation of a facility's reimbursement rate pursuant to Section 145.80(b).