Posted November 5, 2001
What is an appealable initial determination?
A finding of Substandard Quality Care by Health Care Financing Administration (AHCFA@) resulting in withdraw of a provider=s Nurse Aid Training Competency Evaluation Program.
Who is eligible for appeal?
This regulatory change applies to Medicare only or dually participating facilities. Medicaid-only facilities may obtain appeal rights. HCFA conducts a comparative survey and determines SQC that results in withdraw of NATCEP, or as allowed by the State.
What is the procedure for appeal?
- The state agency notifies the Regional Office by e-mail or fax when SQC finding is documented on the HCFA-2567.
- The Regional Office notification must contain a copy of the notice letter to the facility and the deficiencies which document the SQC.
- If the Regional Office does not agree with the findings, HCFA will notify the State within two working days of receipt of the information
What if you disagree with HCFA=s determination of SQC?
You may request a hearing before an administrative law judge of the Department of Health and Human Services. It is important to note that the loss of NATCEP itself cannot be appealed. You may appeal the finding of SQC which led to NATCEP.
All information in this article is informational only and is not legal advice. Should you have any questions or a situation requiring advice, please contact an attorney.
Copyright 2004 by Garlo Ward, P.C., all rights reserved
Austin, Texas 78752-3714 USA
Telephone: 512-302-1103
Facsimilie: 512-302-3256
Email: Info@Garloward.com
