Missouri § 208.434 - Amount final, when — protest, procedure.

§ 208.434. Amount final, when — protest, procedure.

1.  Each Medicaid managed care organization reimbursement allowance determination shall be final after receipt of written notice from the department of social services, unless the Medicaid managed care organization files a protest with the director of the department of social services setting forth the grounds on which the protest is based, within thirty days from the date of receipt of written notice from the department of social services to the managed care organization.

2.  If a timely protest is filed, the director of the department of social services shall reconsider the determination and, if the Medicaid managed care organization has so requested, the director or the director's designee shall grant the managed care organization a hearing to be held within forty-five days after the protest is filed, unless extended by agreement between the managed care organization and the director.  The director shall issue a final decision within forty-five days of the completion of the hearing.  After reconsideration of the reimbursement allowance determination and a final decision by the director of the department of social services, a managed care organization's appeal of the director's final decision shall be to the administrative hearing commission in accordance with sections 208.156 and 621.055.

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(L. 2005 S.B. 189)

Effective 5-13-05

Expires 9-30-29; see § 208.437

---- end of effective  13 May 2005 ----

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