Current through Register Vol. 46, No. 39, September 25, 2024
(a) The
commissioner may consider only those requests for revisions to certified rates
which are based on:
(1) errors made by the
Office of Mental Health in the calculation of the rate;
(2) errors in the financial or statistical
data submitted to the commissioner by the hospital;
(3) significant changes in the overall
operating costs of a hospital resulting from the implementation of substantial
changes in programs or services approved for implementation under applicable
provisions of the Mental Hygiene Law, Part 366, Part 551, and Part 1010 of this
Title; and
(4) significant changes
in the overall capital costs of a hospital resulting from substantial capital
projects approved under applicable provisions of the Mental Hygiene Law, Part
366, Part 551, and Part 1010 of this Title.
(b) Request for revision of a certified rate
shall be sent to the commissioner by registered or certified mail and shall
contain a detailed statement of the basis for the requested revision together
with copies of any documentation the hospital wishes to submit.
(1) A request based upon the grounds set
forth in paragraph (a)(2) of this section must be accompanied by a detailed
statement of the corrected financial or statistical data certified in
accordance with the requirements of section
577.5(b)(2)
of this Part.
(2) A request based
upon the grounds set forth in paragraph (a)(1) or (2) of this section must be
submitted within 120 days of receipt by the hospital of the rate computation
sheet.
(3) A request based upon the
grounds set forth in paragraph (a)(3) or (4) of this section must be submitted
within 60 days of the end of the rate year.
(c) The hospital shall be notified in writing
of the determination of the request for revision of a certified rate, including
a statement of the reasons therefor.
(d)
(1) The
affirmation or revision of the certified rates resulting from such
determination shall be final unless within 30 days of receipt of such written
determination the hospital requests administrative review of the determination.
Request for administration review of a determination to affirm or revise the
certified rate shall be sent to the commissioner by registered or certified
mail and shall contain a detailed statement of the hospital's objections to the
determination, along with copies of any additional documentation the hospital
wishes to submit.
(2) The hospital
shall be notified in writing of the determination after administrative review
including a statement of the reasons therefor. The determination after
administrative reviews shall be final and any rate revision resulting therefrom
shall be implemented in accordance with subdivision (g) of this
section.
(f) Within 30 days of
receipt of the final determination after administrative review, the hospital
may request a hearing on factual issues determined adversely to the hospital in
the administrative review. Requests for hearing, and the conduct thereof, shall
be in accordance with the provisions of Part 503 of this Title.
(g)
(1)
Revisions to rates determined in accordance with the provisions of paragraph
(a)(1) or (2) of this section shall be effective on the first day for which the
originally certified rate was effective.
(2) Revisions to rates determined in
accordance with the provisions of paragraph (a)(3) or (4) of this section shall
be effective on the first day of the calendar month following 30 days after
receipt by the commissioner of the request and documentation or 30 days after
implementation of changes in programs or services or completion of capital
projects, whichever is later.
