2001 -- S 0614

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LC02130
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RELATING TO MEDICAL ASSISTANCE

It is enacted by the General Assembly as follows:

SECTION 1. Section 40-8-21 of the General Laws in Chapter 40-8 entitled "Medical Assistance" is hereby amended to read as follows:

40-8-21. Appeals process. -- (a) Results of exit audit conferences or rate appeal conferences shall be in writing, shall include the reasoning on which the result is based, and shall be available to the public in accordance with chapter 38-2 of the general laws. Any nursing facility provider that is not in agreement, after being provided an exit audit conference or rate appeal conference, with a final medical assistance rate of reimbursement assigned as a result of an audit for its base year, or with the application of the principles of reimbursement for an applicable year, may within fifteen (15) days from the date of notification of audit results or rate adjustment or assignment, file a written request with the department for a review of the computation of the assigned rate conference. Such request must identify the remaining contested audit adjustment(s) or rate assignment issue(s) in a short and plain statement.

(b) A review conference will be conducted within fifteen (15) days from the date of receipt of the written request by a designee assigned by the director of the department of human services. The review conference shall be scheduled within fifteen (15) days of the department's receipt of said request. The provider shall be entitled to present evidence and call witnesses at the review conference and may be represented by counsel or other representatives. As a result of the review conference, the designee may modify the audit adjustments and/or the rate of reimbursement. The designee shall provide the facility provider with a written decision within thirty (30) days from the date of the review conference. , including a complete and reasoned rationale for the decision incorporating citations to all laws and regulations supporting such decision. The written decision shall be a public document in accordance with chapter 38-2 of the general laws. If decision is not rendered within thirty (30) days from the date of the review conference, the nursing facility's request will be deemed to be approved.

(c) Appeals beyond the review conference shall be in accordance with the provisions of chapter 35 of title 42. The facility shall file a written request for the hearing no later than fifteen (15) days after receipt of the review conference decision.

SECTION 2. This act shall take effect upon passage.

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LC02130
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF

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This act would provide that persons eligible for medical assistance exit audit conferences or rate appeals results will be in writing, reasoned and available to the public, and also establishes review conferences procedures.

This act would take effect upon passage.