208.434. Amount final, when--protest, procedure. - Missouri Statutes

Amount final, when--protest, procedure.

208.434. 1. Each Medicaid managed care organization reimbursementallowance determination shall be final after receipt of written notice fromthe department of social services, unless the Medicaid managed careorganization files a protest with the director of the department of socialservices setting forth the grounds on which the protest is based, withinthirty days from the date of receipt of written notice from the departmentof social services to the managed care organization.

2. If a timely protest is filed, the director of the department ofsocial services shall reconsider the determination and, if the Medicaidmanaged care organization has so requested, the director or the director'sdesignee shall grant the managed care organization a hearing to be heldwithin forty-five days after the protest is filed, unless extended byagreement between the managed care organization and the director. Thedirector shall issue a final decision within forty-five days of thecompletion of the hearing. After reconsideration of the reimbursementallowance determination and a final decision by the director of thedepartment of social services, a managed care organization's appeal of thedirector's final decision shall be to the administrative hearing commissionin accordance with sections 208.156 and 621.055, RSMo.

(L. 2005 S.B. 189)

Effective 5-13-05

Expires 9-30-11