La. Admin. Code tit. 50 § I-4213

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-4213 - Right to Administrative Appeal and Review

A. Only the imposing of one or more sanctions can be appealed to the Division of Administrative Law.

1. The adversely effected party has the right to challenge the basis for the violation and the sanction imposed.

2. The adversely effected party must specifically state the basis for the appeal and what actions are being challenged on appeal.

B. The following actions are not sanctions, even if listed as such in the notice of sanction or notice of the results of the informal hearing, and are not subject to appeal or review by the Division of Administrative Law:

1. referral to a state, federal or professional licensing authority;

2. referral to the Louisiana Attorney General = s Medicaid Fraud Control Unit or any other authorized law enforcement or prosecutorial authority;

3. referral to governing boards, peer review groups or similar entities;

4. issuing a warning to a provider or provider-in-fact or other person through written notice or consultation;

5. require that the provider, or provider-in-fact, their affiliates and agents receive education and training in laws, rules, policies, and procedures, including billing;

6. conducting prepayment review;

7. place the provider's claims on manual review status before payment is made;

8. require that the provider or provider-in-fact receive prior authorization for any or all goods, services, or supplies under the Medicaid Program or one or more of its programs;

9. remove or restrict the provider = s use of electronic billing;

10. any restrictions imposed as the result of a corrective action plan;

11. any restrictions agreed to by a provider, provider-in-fact, agent of the provider, or affiliate of the provider;

12. any terms or conditions contained in an arrangement to repay which has been agreed to by a provider, provider-in-fact, agent of the provider, or affiliate of the provider.

La. Admin. Code tit. 50, § I-4213

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 25:1649 (September 1999), repromulgated LR 29:603 (April 2003), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38: 2788 (November 2012).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, 46:437.4 and 46:437.1-46:440.3 (Medical Assistance Program Integrity Law).