10A N.C. Admin. Code 22F.0402

Current through Register Vol. 39, No. 12, December 1, 2024

Section 22F .0402 - RECONSIDERATION REVIEW FOR PROGRAM ABUSE

(a) The Division shall notify the provider in writing by certified mail of the tentative decision made pursuant to Rule .0302 of this subchapter and the opportunity for a reconsideration of the tentative decision.

(b) The provider shall be instructed to submit to the Division in writing a request for a Reconsideration Review within 30 business days from the date of receipt of the notice. Failure to request a Reconsideration Review in the specified time shall result in the implementation of the tentative decision as the Division's final decision.

(c) The Notice of Reconsideration Review shall be sent to the provider within 30 business days from receipt of the request. The provider shall be notified in writing to appear at a specified day, time, and place. The provider may be accompanied by legal counsel if the provider so desires.

(d) The provider shall provide a written statement to the Hearing Unit prior to the Reconsideration Review identifying any claims that the provider wishes to dispute and setting forth the provider's specific reasons for disputing the determination on those claims.

(e) The purpose of the Reconsideration Review includes:

(1) clarification formulation, and simplification of issues;

(2) exchange and full disclosure of information and materials;

(3) review of the investigative findings;

(4) resolution of matters in controversy;

(5) consideration of mitigating and extenuating circumstances;

(6) reconsideration of the administrative measures to be imposed; and

(7) reconsideration of the restitution of overpayments.

(f) The Reconsideration Review decision shall be sent to the provider, in writing by certified mail, within 30 business days following the date the review record is closed. The review record is closed when all arguments and documents for review have been received by the Hearing Unit. The decision shall state that the provider may request a contested case hearing in accordance with G.S. 150B, Article 3 and 26 NCAC 03 .0103. Pursuant to G.S. 150B-23(f), the provider shall have 60 days from receipt of the Reconsideration Review decision to request a contested case hearing in the Office of Administrative Hearings. Unless the request is received within the time provided, the Reconsideration Review decision shall become the Division's final decision and no further appeal shall be permitted.

10A N.C. Admin. Code 22F .0402

Authority G.S. 108A-25(b); 108A-54; 150B, Article 3; S.L. 2011-375, s. 2; 42 C.F.R. Part 455.512;
Eff. April 15, 1977;
Readopted Eff. October 31, 1977;
ARRC Objection October 22, 1987;
Amended Eff. November 1, 1988; March 1, 1988; May 1, 1984;
Readopted Eff. July 1, 2018.

Authority G.S. 108A-25(b); 108A-54; 150B-22; 42 C.F.R. Part 455;
Eff. April 15, 1977;
Readopted Eff. October 31, 1977;
ARRC Objection October 22, 1987;
Amended Eff. November 1, 1988; March 1, 1988; May 1, 1984.

Readopted by North Carolina Register Volume 33, Issue 03, August 01, 2018 effective 7/1/2018.