DADS has issued Provider Letter 11-11 outlining changes for requirements to informal review requests for cost reports, effective September 1, 2011. Beginning September 1, if a provider submits an informal review request that does not meet the requirements of 1 TAC §355.110(c)(1)(B) the request will not be accepted. Under 1 TAC §355.110(c)(1)(B), a provider must submit the following with its request for informal review:
- A concise statement of the specific actions or determinations disputed;
- A recommended resolution; and
- Any supporting documentation relevant to the dispute.
Provider Letter 11-11 further states that if a provider is disputing a cost report adjustment, the provider must include a description of the cost report item they are disputing, what they believe the correct value of the item should be, why they believe this, and supporting documentation (such as payroll records, timesheets, canceled checks, etc.). If a provider is submitting a correction to a cost report, the provider must include a description of the cost report item they are correcting, what they believe the correct value of the item should be, why they believe this, and documentation that supports their corrected value (see above for examples).
Prior to September 1, 2011, if a provider submitted an informal review request that did not meet these requirements, HHSC would accept the request for review and request the additional information through a certified mailing, giving the interested party an additional 15 days to provide the information. Garlo Ward has prepared and submitted numerous informal review requests for clients over the years. We have always included a detailed description of the cost report line items disputed, with a thorough explanation of our recommended resolution per line item and attached all available and applicable supporting documents.
As noted above, as of September 1, 2011, requests for informal review that do not include the required information will be denied and not subject to further appeal. Meaning, providers will no longer get a second chance to make up for a deficient informal review request. Don’t let this happen to you! Garlo Ward can help you gather the information necessary and draft a request for informal review that meets the rule requirements.
