Section 405 IAC 1-1.4-13 - Summary reviewAuthority: IC 12-15-21
Affected: IC 4-21.5-3
Sec. 13.
(a) The office shall provide a summary review of certain issues set out in the provider's statement of issues. Issues in the provider's statement of issues that challenge the propriety of all or part of the general methodology or criteria utilized by the office for:(3) making determinations with respect to change of provider status for purposes of setting a rate of reimbursement; or(4) determination that an overpayment has been made to a provider due to a year-end cost-settlement; shall be certified for summary review by the secretary.(b) The office shall not certify for summary review any issue in which the provider challenges the application of the office's methodology or criteria in the provider's particular circumstances. Issues involving application of the office's methodology or criteria shall be set for an evidentiary hearing under IC 4-21.5-3. The administrative law judge shall exclude any: (1) evidence or argumentation on issues certified to the secretary; or(2) issues not specifically enumerated in the provider's statement or amended statement of issues.(c) There shall be no appeal from a determination by the office certifying any issues for summary review.(d) Upon a determination of the office that any or all of the issues in the provider's statement of issues concern those items listed in subsection (a), the office shall certify those issues for summary review. With respect to each issue certified by the office, the office shall, with respect to the office's determination: (3) remand the decision to an administrative law judge for an evidentiary hearing.(e) The decision of the office on summary review shall be rendered within forty-five (45) calendar days after certification by the office.(f) The office shall send a notice of the decision on summary review to the provider. The decision on summary review of the office is interlocutory unless it adjudicates all the issues in the provider's appeal. It is not a final order until all issues in the provider's statement of issues are adjudicated by the secretary or the secretary's designee under IC 4-21.5-3-28. A provider may not seek judicial review of an adverse determination of the office on summary review until such time as a final order on all the issues in the provider's statement of issues is rendered.Office of the Secretary of Family and Social Services; 405 IAC 1-1.4-13; filed 12/21/2018, 3:17 p.m.: 20190116-IR-405180251FRAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA