Rule 67:16:04:37 Audits -- Appeal provisions.
-- Appeal provisions. The department shall conduct desk audits of the
statistical and cost reports submitted under § 67:16:04:34. If a field
audit is conducted, the auditor shall hold an exit conference with
representatives from the facility to discuss and explain the preliminary audit
findings. Following the exit conference, the auditor shall prepare written
audit findings and comments and shall mail a copy to the facility.
The facility has 30 calendar days
following receipt of a desk or field audit report to contest an adjustment or a
disallowed expenditure by requesting an administrative hearing under the
provisions of chapter 67:17:02. The department may extend this time limit at
the request of the provider. Such an extension may not exceed 30 calendar days.
The department may not accept additional documentation from the provider once
the time limit has expired. At the hearing, the burden of proof is on the
provider to demonstrate its entitlement to Medicaid reimbursement by a preponderance
of the evidence.
15 SDR 68, effective November 7, 1988; 16 SDR 26, effective August 13, 1989;
transferred from § 67:16:04:07.02, 21 SDR 8, effective July 25, 1994; 35
SDR 312, effective July 6, 2009.
Authority: SDCL 28-6-1.
Implemented: SDCL 28-6-1.
Time limits for requesting hearing, § 67:16:04:38.
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