Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1736 - PROVIDER PROVISIONS
Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW
Section 17-1736-58 - Hospital and institutional provider's right to review

Universal Citation: HI Admin Rules 17-1736-58

Current through August, 2024

(a) A provider may request an administrative hearing if it is dissatisfied with the department's determination of medicaid reimbursement:

(1) Following any request for rate reconsideration determination under PPS; or

(2) Following the issuance of an NPR under cost reimbursement; and

(3) The amount in dispute is at least $1,000.

(b) A written request for administrative hearing must be received by the department within ninety days from the date of the rate reconsideration determination or NPR as provided in subsection (a) and shall refer to that specific notification.

(c) The provider's request for an administrative hearing shall include the following:

(1) Individual adjustment items and the specific reimbursement issue and the dollar amount entailed;

(2) The reasons for the disagreement;

(3) Any material or evidence the provider considers necessary to support its position; and

(4) The notice with which the provider disagrees.

(d) A group of providers may request an administrative hearing if the issue involves a common question of fact or interpretation, and the amount in controversy is in the aggregate of $50,000 or more.

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