Current through Register Vol. 48, No. 12, March 22, 2024
a) A provider may file an objection, in
limited circumstances, if a certification request is denied by the
Department.
b) Examples of
circumstances that do not constitute an appealable basis for objection include:
1) timing of initiation of certification
process by the Department;
2)
termination of eligibility by closure of the file due to a provider's failure
to comply with time frames for submitting a certification request under Section
240.1600(b);
3) new supporting documentation to establish
eligibility for certification or recertification as a service provider under
the CCP following failure to comply with time frames for submitting material
requested by the Department;
4)
issues upon which the Department has already made a final administrative
decision as a result of a previous objection or contract action involving the
provider;
5) issues upon which an
independent trier of fact has made a final determination or issued an
order;
6) disputes as to service
rates or the underlying methodology for calculating those rates;
7) duration of a service provider
certification;
8) timing of the
Provider Agreement process by the Department; or
9) other matters of general applicability
that are not specifically adverse to the provider.
c) Procedures for Filing an Objection
1) An objection regarding a certification
decision must be in writing and must be received at the Department's
Springfield office on or before the 10th calendar
day after the date of the applicant's receipt of the notice of the
objectionable action. If the objection is not received before the close of
business on the 10th tenth calendar day, the
objection shall be disregarded.
2)
Each objection must contain a full and concise statement of the facts and
circumstances of the action that is alleged to be objectionable, legally or
otherwise, and a statement of the relief sought.
A) The Department may request additional
details at any time.
B) Failure to
supply any information requested by the Department will be cause for dismissal
of the objection.
d) Upon receipt of written objection, the
Department shall immediately review the certification decision in question and
shall issue a written response. The certification decision shall not be
considered final until any relevant objections are resolved.
e) The decision of the Director is final and
shall be sent by certified mail, return receipt requested, or by any other
means that allows the Department to document and confirm receipt by the
applicant of the decision.