California § 11468.2 - A provider who disagrees with a rate determination and who desires a different ra

§ 11468.2. A provider who disagrees with a rate determination and who desires a different ra

(a) A provider who disagrees with a rate determination and who desires a different rate, or who has been denied a rate or had a rate terminated, may file a protest with the department within 60 days from the date of the mailing of the notification of the set rate. The protest shall include all information including documentation for the department to determine the provider’s basis for requesting a different set rate or challenge of the audit findings that affect the rate. The department may request additional documentation or information from the provider after reviewing the protest. (b) Within 90 days of receipt of the final documentation or information, the department shall issue a decision letter indicating the department’s decision on the protest which shall include the department’s basis for the action taken. This time period may be extended by the department for good cause. (c) If the provider does not concur with the rate protest decision letter, a written appeal may be filed with the department within 60 days of receipt of the decision letter. The appeal shall be accompanied with full supporting documentation. The department may request additional information.