A. All hospitals will be notified of their eligibility status for the disproportionate share payment and of their disproportionate share rate, by certified mail. A hospital administrator may request reconsideration of a program decision by writing to the Assistant Director, Division of Medical Services. This request must be received within 20 calendar days following receipt of the certified letter, which notifies the hospital of their disproportionate eligibility status and/or rate. Upon receipt of the request for review, the Assistant Director will determine the need for a program/provider conference if needed.

Regardless of the program decision, the provider will be afforded the opportunity for a conference if he so wishes for a full explanation of the factors involved in the program decision. Following review of the appeal request, the Assistant Director will notify the hospital of the action to be taken by the Division within 20 calendar days of receipt of the request for review or the date of the program/provider conference.

B. If the decision of the Assistant Director, Division of Medical Services, is unsatisfactory, the facility may then appeal the question to a standing Rate Review Panel established by the Director of the Division of Medical Services which will include one member of the Division of Medical Services, a representative of the Arkansas Hospital Association and a member of the Department of Human Services (DHS) Management Staff who will serve as chairman.

The request for review by the Rate Review Panel must be postmarked within 15 calendar days following the notification of the initial decision by the Assistant Director, Division of Medical Services. The Rate Review Panel will meet to consider the question within 15 calendar days after receipt of a request for such appeal. The question will be heard by the panel and a recommendation will be submitted to the Director of the Division of Medical Services for approval. View or print form DMS-628, Medicaid Low Income Utilization Schedule for Determination of Disproportionate Share Eligibility.