Section 405IAC1-1.5-3. Summary review

   (a) The office of Medicaid policy and planning (office) will provide a summary review by the secretary of family and social services administration (secretary) of certain issues set out in the provider's statement of issues. Issues in the provider's statement of issues that challenge the propriety of:

(1) all or part of the general methodology or criteria utilized by the office for setting rates;

(2) all or part of the general methodology or criteria utilized by the office with respect to any audits;

(3) all or part of the general methodology or criteria utilized by the office for making determinations with respect to change of provider status; and

(4) all or part of any other general methodology or criteria utilized by the office for making any determination set out in section 1(b) of this rule;

will be certified for summary review by the secretary.

  (b) The office shall not certify for summary review any issue in which the provider challenges the application of the office's methodology or criteria in the provider's particular circumstances. Issues involving application of the office's methodology or criteria will be set for an evidentiary hearing under IC 4-21.5-3. The administrative law judge shall exclude any:

(1) evidence or argumentation on issues certified to the secretary; or

(2) issues not specifically enumerated in the provider's statement or amended statement of issues.

  (c) For appeals filed before the effective date of this rule, the office may certify issues determined under subsection (a) to the secretary or the secretary's designee, according to the issues set out in the provider's appeal letter.

  (d) There shall be no appeal from a determination by the office certifying any issues for summary review by the secretary. (Office of the Secretary of Family and Social Services; 405 IAC 1-1.5-3; filed Oct 31, 1994, 3:30 p.m.: 18 IR 863; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA)