NDAC 75-02-09-18
Reconsiderations and appeals
Cite as N.D. Admin. Code § 75-02-09-18
1.
Reconsiderations.
a.
A facility dissatisfied with the final rate established must request a reconsideration of the
final rate before a formal appeal may be made. Any requests for reconsideration must be
filed with the department's medical services division within thirty days of the date of the
rate notification.
b.
A request for reconsideration must include:
(1)
A statement of each disputed item and the reason or basis for the dispute;
(2)
The dollar amount of each item that is disputed; and
(3)
The statute or rule upon which the facility is relying for each disputed item.
c.
The department may request additional documentation or information relating to a
disputed item. If additional documentation is not provided within fourteen days of the
department's request, the department shall make its determination based on the
information and documentation available as of the fourteenth day following the date the
department requested additional documentation.
d.
The department's medical services division shall make a determination regarding the
reconsideration within forty-five days of receiving the reconsideration filing and any
requested documentation.
2.
Appeals.
a.
A facility dissatisfied with the final rate established may appeal upon completion of the
reconsideration process as provided in subsection 1. An appeal must be filed with the
department within thirty days of the date on the written notice of the determination by the
medical services division with respect to a request for reconsideration.
b.
An appeal under this section is timely perfected only if accompanied by written
documents, including:
(1)
A copy of the letter received from the department's medical services division
advising of that division's decision on the request for reconsideration;
(2)
A statement of each disputed item and the reason or basis for the dispute;
(3)
A computation and the dollar amount which reflects the appealing party's claim as to
the correct computation and dollar amount for each disputed item;
(4)
The authority in statute or rule upon which the appealing party relies for each
disputed item; and
(5)
The name, address, and telephone number of the person upon whom all notices will
be served regarding the appeal.