Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) The contractor may request an informal
hearing by the Department of Health Services for any disputed issue arising out
of the audit or examination of a direct service contract, including whether or
not there exists a qualified underpayment and, if so, whether or not it should
be subject to statistical extrapolation.
(b) Disputes arising out of the audit or
examination of a direct service contract, shall proceed in accordance with the
following procedures:
(1) The contractor may
request an informal hearing by the Department of Health Services by filing a
written request with the Department within 60 calendar days of the date of
mailing of the audit or examination notice. The request shall identify the
issues in dispute and shall include any supporting documents.
(2) The contractor's request for an informal
hearing shall be sent to the Deputy Director for Public Health. The Deputy
Director for Public Health or his/her designee shall meet with the contractor
to review the issues raised. A written decision signed by the Deputy Director
for Public Health or his/her designee shall be returned to the contractor
within 20 working days of receipt of the contractor's request for an informal
hearing.
(3) All late requests by
the contractor shall be denied and the Department's audit or examination report
shall be deemed final unless the contractor establishes with the Department, in
writing, good cause, as judged by the Deputy Director of Public Health, for
late filing within 15 calendar days of being notified of the untimeliness of
its request.
(4) If the contractor
wishes to appeal the decision of the Deputy Director for Public Health or
his/her designee, the contractor shall follow the procedures set forth in
Division 25.1 (commencing with Section
38050)
of the Health and Safety Code and the regulations adopted thereunder (Section
251, Title 1, CCR).
(c)
Disputes arising out of direct service contracts which are not the result of an
audit or examination shall proceed in accordance with the following procedures:
(1) The contractor shall first discuss the
problem informally with the applicable program contract administrator within
the Department. If the problem cannot be resolved at this stage, the contractor
shall direct his/her grievance, together with any evidence, in writing, to the
program branch chief. The grievance shall state the issues in the dispute, the
legal authority or other basis for the contractor's position, and the remedy
sought. The applicable program branch chief shall make a determination on the
problem within ten (10) working days after receipt of the written communication
from the contractor, indicating the decision and reasons therefore. Should the
contractor disagree with the branch chief's decision, the contractor may appeal
pursuant to (2) below.
(2) The
contractor shall prepare a letter indicating the reasons for disagreement with
the branch chief's decision. The contractor shall include with the letter a
copy of the original statement of the dispute, any supporting documents, and a
copy of the branch chief's response. This letter shall be sent to the Deputy
Director in which the branch is organized within ten (10) working days from
receipt of the branch chief's decision. The Deputy Director or designee shall
meet with the contractor to review the issues raised. A written decision signed
by the Deputy Director or designee shall be returned to the contractor within
20 working days of receipt of the contractor's letter.
(3) If the contractor wishes to appeal the
decision of the Deputy Director or designee, the contractor shall follow the
procedures set forth in Division 25.1 (commencing with Section
38050)
of the Health and Safety Code and the regulations adopted thereunder (Section
251, Title 1, CCR).
(d)
Disputes arising out of contracts other than direct service contracts shall be
handled in accordance with any specific statute or regulation applicable to the
contract or, in accordance with the terms of the individual contract.
(e) Disputes arising out of an audit or
examination of a contract not covered by subdivision (a) and for which no
procedures for appeal are provided in statute, regulation or the contract shall
be handled in accordance with the procedures identified in Sections
51016 through
51047, Title 22, CCR.
1. New
section filed 5-31-89; operative 6-30-89 (Register 89, No. 23).
2.
Change without regulatory effect of subsection (b)(3) pursuant to Section
100, Title 1, California Code of
Regulations filed 2-20-90 (Register 90, No. 11).
Note: Authority cited: Section
10725,
Welfare and Institutions Code; and Sections 208 and
38036,
Health and Safety Code. Reference: Sections
38036
and
38055,
Health and Safety Code; Sections
11180 and
11181,
Government Code; and Stipulated Judgment in Planned Parenthood v. Department of
Health Services, Sacramento Superior Court, No.
328490.
