Administrative Review

(1) Purpose of Administrative Review. If the Division receives information from any source that indicates that a provider’s rate may be based upon inaccurate or outdated information, it may initiate an administrative review to determine if a rate reduction is warranted. The reasons for which the Division may initiate the review include, but are not limited to: to ensure that costs included in the rate were actually incurred, to ensure that costs were properly reported, or to determine whether a rate should be adjusted to reflect a major change in services which occurred after the base year. (2) Notice of Administrative Review. The Division may at any time review the rates upon notice to the hospital. the Division shall initiate administrative review by notifying the hospital and the purchasers that it intends to conduct anadministrative review. The notificationshallbe in writing and shall include a statement of reason for the review. (3) Request for Information. The Division may request that the provider submit books, records and other information necessary for its review. (4) Results of Administrative Review. After review, the Division will render a written decision and statement of reasons for its decision.