1.For purposes of this section:
a."Final decision rate" means the amount, if any, determined on a per day basis, by
which a rate otherwise set under this chapter is increased as a result of a request
for reconsideration made under section 50-24.4-17, a request for an
administrative appeal under section 50-24.4-18, or a request for judicial appeal
under chapter 28-32 taken from a decision on an administrative appeal.
b."Pending decision rate" means the amount, determined on a per day basis, by
which a rate otherwise set under this chapter would increase if a nursing home
prevails on a request for reconsideration made under section 50-24.4-17, on a
request for an administrative appeal under section 50-24.4-18, or on a request for
a judicial appeal under chapter 28-32 taken from a decisio
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1. For purposes of this section:
a. "Final decision rate" means the amount, if any, determined on a per day basis, by
which a rate otherwise set under this chapter is increased as a result of a request
for reconsideration made under section 50-24.4-17, a request for an
administrative appeal under section 50-24.4-18, or a request for judicial appeal
under chapter 28-32 taken from a decision on an administrative appeal.
b. "Pending decision rate" means the amount, determined on a per day basis, by
which a rate otherwise set under this chapter would increase if a nursing home
prevails on a request for reconsideration made under section 50-24.4-17, on a
request for an administrative appeal under section 50-24.4-18, or on a request for
a judicial appeal under chapter 28-32 taken from a decision on an administrative
appeal; however, the amount may not cause any component of the rate to exceed
rate limits established under this chapter or through rules adopted under section
50-24.4-02.
2. If a nursing home has made a request for reconsideration under section 50-24.4-17,
taken an administrative appeal under section 50-24.4-18, or taken a judicial appeal
under chapter 28-32 from a decision on an administrative appeal, and has provided
information sufficient to allow the department to accurately calculate, on a per day
basis, the effect of each of the disputed issues on the nursing home's rate, the
department shall determine and issue a pending decision rate within thirty days of
receipt of the request for reconsideration, administrative appeal, or judicial appeal. If
the information furnished is insufficient to determine a pending decision rate, the
department, within thirty days of receipt of the request for reconsideration, shall inform
the facility of the insufficiency and may identify information that would correct the
insufficiency.
3. The department shall add the pending decision rate to the rate that would otherwise be
set under this chapter, and, notwithstanding section 50-24.4-19, the total must be the
rate chargeable to private-paying residents until a final decision on the request for
reconsideration or appeal is made and is no longer subject to further appeal.
4. The nursing home shall establish and maintain records that reflect the amount of any
pending decision rate paid by each private-paying resident from the date the nursing
home charges a private-paying resident the pending decision rate.
5. If the pending decision rate paid by a private-paying resident exceeds the final
decision rate, the nursing home shall refund the difference, plus interest at the legal
rate, within sixty days after the final decision is no longer subject to appeal. If a nursing
home fails to provide a timely refund to a living resident or former resident, the nursing
home shall pay interest at three times the legal rate for the period after the refund is
due. If a former resident is deceased, the nursing home shall pay the refund to a
person lawfully administering the estate of the deceased former resident or lawfully
acting as successor to the deceased former resident. If no person is lawfully
administering the estate or lawfully acting as a successor, the nursing home may make
any disposition of the refund permitted by law. Interest paid under this subsection is a
nonallowable cost.