10A NCAC 22F .0402        RECONSIDERATION REVIEW FOR PROGRAM ABUSE

(a)  Upon notification of a tentative decision the provider will be offered, in writing, by certified mail, the opportunity for a reconsideration of the tentative decision and the reasons therefor.

(b)  The provider will be instructed to submit to the Division in writing his request for a Reconsideration Review within fifteen working days from the date of receipt of the notice.  Failure to request a Reconsideration Review in the specified time shall result in the implementation of the tentative decision as the Division's final decision.

(c)  If requested, the Reconsideration Review shall be scheduled within twenty calendar days from receipt of the request.  The provider will be notified in writing to appear at a specified day, time and place.  The provider may be accompanied by legal counsel if he so desires.

(d)  The purpose of the Reconsideration Review includes:

(1)           Clarification, formulation, and simplification of issues;

(2)           Exchange and full disclosure of information and materials;

(3)           Review of the investigative findings;

(4)           Resolution of matters in controversy;

(5)           Consideration of mitigating and extenuating circumstances;

(6)           Reconsideration of the administrative measures to be imposed;

(7)           Reconsideration of the restitution of overpayments.

(e)  The Reconsideration Review decision will be sent to the provider in writing by certified mail within five working days following the date of review.  It will state the schedule for implementing the administrative measures and/or recoupment plan, if applicable, and it will state that if the Reconsideration Review decision is not acceptable to the provider, he may request a contested case hearing in accordance with the provisions found at 10A NCAC 01.  Pursuant to G.S. 150B‑23(f), the provider shall have 60 days from receipt of the Reconsideration Review decision to request a contested case hearing.  Unless the request is received within the time provided, the Reconsideration Review decision shall become the Division's final decision.  In processing the contested case request, the Director of the Division of Medical Assistance shall serve as the secretary's designee and shall be responsible for making the final agency decision.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 150B‑22; 42 C.F.R. Part 455;

Eff. April 15, 1977;

Readopted Eff. October 31, 1977;

ARRC Objection October 22, 1987;

Amended Eff. November 1, 1988; March 1, 1988; May 1, 1984.