Ala. Admin. Code r. 560-X-57-.09

Current through Register Vol. 43, No. 02, November 27, 2024

Section 560-X-57-.09 - Appeal Procedure For Medicaid Fiscal Audits

(1) Fiscal audits of the SAIL 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 Associate Director of 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, they may request an informal conference with the Director of the Provider Audit Division.

(2) To request the informal conference, the operating agency must submit a letter within thirty 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:

Attn: Director

Provider Audit Division

Alabama Medicaid Agency

501 Dexter Avenue

Post Office Box 5624

Montgomery, Alabama 36103-5624

(3) The decisions of the Director, 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, they will have 15 days from the date of the letter to request a fair hearing.

Ala. Admin. Code r. 560-X-57-.09

Emergency rule effective April 1, 1992. Permanent rule effective June 12, 1992. Amended: September 6, 1996; effective October 12, 1996. Amended: Filed June 11, 2003; effective July 16, 2003. Amended: Filed August 11, 2008; effective September 15, 2008.

Author: Latonda Cunningham, Administrator, LTC Project Development/Program Support Unit

Statutory Authority:42 C.F.R. §431, Subpart E.