South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:04 - Nursing facility rate setting
Section 67:16:04:37 - Audits - Appeal provisions

The department shall conduct desk audits of the statistical and cost reports submitted under § 67:16:04:34. If a field audit is conducted, the auditor shall hold an exit conference with representatives from the facility to discuss and explain the preliminary audit findings. Following the exit conference, the auditor shall prepare written audit findings and comments and shall mail a copy to the facility.

The facility has 30 calendar days following receipt of a desk or field audit report to contest an adjustment or a disallowed expenditure by requesting an administrative hearing under the provisions of chapter 67:17:02. The department may extend this time limit at the request of the provider. Such an extension may not exceed 30 calendar days. The department may not accept additional documentation from the provider once the time limit has expired. At the hearing, the burden of proof is on the provider to demonstrate its entitlement to Medicaid reimbursement by a preponderance of the evidence.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Time limits for requesting hearing, § 67:16:04:38.