Ala. Admin. Code r. 560-X-36-.11

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-36-.11 - Appeal Procedure For Fiscal Audit

(1) Fiscal audits of the Elderly and Disabled Waiver Services are conducted by the Provider Audit Division of Medicaid. At the completion of the field audit there will be an exit conference with the operating agency to explain the audit findings. The operating agency will have the opportunity to express agreement or disagreement with the findings. The field audit and the comments of the operating agency are reviewed by the Provider Audit Division and a letter is prepared making the appropriate findings official. If the operating agency deems that the findings are not justified, it may request an informal conference with the Director of the Provider Audit Division.

(2) The request for an informal conference must be in writing and received by Medicaid within 30 days from the date of the official audit letter. This letter must specify the findings that are contested and the basis for the contention. This letter should be addressed to the attention of:

Director

Provider Audit Division.

(3) The decisions of the Provider Audit Division made as a result of the informal conference will be forwarded to the operating agency by letter. If the operating agency believes that the results of the informal conference are still adverse, it may request a fair hearing. The request must be in writing and received by Medicaid within 15 days from the date of the informal conference decision letter.

Ala. Admin. Code r. 560-X-36-.11

New Rule: Filed September 11, 2008; effective October 16, 2008.

Author: Ginger Wettingfeld, Administrator, LTC Project Development/Program Support Unit

Statutory Authority:42 CFR Section 431, Subpart E.