§ 12-15-13-4 — Recovery of overpayment to institutional provider; appeal

Indiana § 12-15-13-4

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 13: Provider Payment; General

Text

(a) As used in this section, "institutional
provider" means the following:
(1) A health facility that is licensed under IC 16-28.
(2) An ICF/IID (as defined in IC 16-29-4-2).
(b) If the office of the secretary or the office of the secretary's
designee believes that an overpayment to an institutional provider has
occurred, the office of the secretary or the office of the secretary's
designee may do the following:
(1) Submit to the institutional provider a draft of the audit
findings and accept comments from the institutional provider for
consideration by the office of the secretary or the office of the
secretary's designee before the audit findings are finalized.
(2) Finalize the audit findings and issue the preliminary
recalculated Medicaid rate.
(c) An institutional provider that receives a preliminary recalculated
Medicaid rate under subsection (b)(2) may request administrative
reconsideration of the preliminary recalculated Medicaid rate not later
than forty-five (45) days after the issuance of the preliminary
recalculated rate. The institutional provider must request administrative
reconsideration before filing an appeal.
(d) Following reconsideration of an institutional provider's
comments, and if the office of the secretary or the office of the
secretary's designee believes that an overpayment has occurred, the
office of the secretary or the office of the secretary's designee shall
notify the institutional provider in writing that the office of the
secretary or the office of the secretary's designee:
(1) believes that the overpayment has occurred; and
(2) is issuing a final recalculated Medicaid rate.
(e) Upon the next payment cycle, the office of the secretary or the
office of the secretary's designee shall retroactively implement the final
recalculated Medicaid rate.
(f) If the institutional provider is dissatisfied with the
reconsideration response issued by the office of the secretary or the
office of the secretary's designee, the institutional provider may request
a hearing by filing an appeal with the office of the secretary not later
than sixty (60) days after the issuance of the reconsideration response.
(g) If an institutional provider requests a hearing under subsection
(f) and the office of the secretary or the office of the secretary's
designee determines after the hearing and any subsequent appeal that
the institutional provider does not owe the money that the office of the
secretary or the office of the secretary's designee believed the
institutional provider owed, the office of the secretary or the office of
the secretary's designee shall repay the following to the institutional
provider not later than thirty (30) days after the completion of the
hearing:
(1) The amount of the alleged overpayment.
(2) Any interest paid by the institutional provider.
(3) Interest on the money described in subdivisions (1) and (2)
from the date of the institutional provider's repayment.
(h) Interest due under this section by either the institutional provider
or the office of the secretary shall be paid at a rate that is determined
by the commissioner of the department of state revenue under IC 6-8.1-10-1(c) at the rate set by the commissioner for interest payments
from the department of state revenue to a taxpayer.
(i) Interest on an overpayment to an institutional provider is not due
from the institutional provider if the office of the secretary or the office
of the secretary's designee determines that the overpayment is the result
of an error by the following:
(1) The office of the secretary.
(2) A contractor of the office of the secretary.
(j) If interest on an overpayment to an institutional provider is due
from the institutional provider, the office of the secretary or the office
of the secretary's designee may, in the course of negotiations with the
institutional provider concerning an appeal filed under this section,
reduce the amount of interest due from the institutional provider.

Legislative History

As added by P.L.229-2011, SEC.126. Amended by P.L.35-2016, SEC.40.