[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR457.212]



[Page 387]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 457_ALLOTMENTS AND GRANTS TO STATES--Table of Contents

 

  Subpart B_General Administration_Reviews and Audits; Withholding for 

  Failure to Comply; Deferral and Disallowance of Claims; Reduction of 

                        Federal Medical Payments

 

Sec.  457.212  Disallowance of claims for FFP.



    (a) Notice of disallowance and of right to reconsideration. When the 

Regional Administrator or the Administrator determines that a claim or 

portion of claim is not allowable, he or she promptly sends the State a 

disallowance letter that includes the following, as appropriate:

    (1) The date or dates on which the State's claim for FFP was made.

    (2) The time period during which the expenditures in question were 

made or claimed to have been made.

    (3) The date and amount of any payment or notice of deferral.

    (4) A statement of the amount of FFP claimed, allowed, and 

disallowed and the manner in which these amounts were computed.

    (5) Findings of fact on which the disallowance determination is 

based or a reference to other documents previously furnished to the 

State or included with the notice (such as a report of a financial 

review or audit) that contain the findings of fact on which the 

disallowance determination is based.

    (6) Pertinent citations to the law, regulations, guides and 

instructions supporting the action taken.

    (7) A request that the State make appropriate adjustment in a 

subsequent expenditure report.

    (8) Notice of the State's right to request reconsideration of the 

disallowance and the time allowed to make the request.

    (9) A statement indicating that the disallowance letter is the 

Department's final decision unless the State requests reconsideration 

under paragraph (b)(2) of this section.

    (b) Reconsideration of FFP disallowance. (1) The Departmental 

Appeals Board reviews disallowances of FFP under title XXI.

    (2) A State may request reconsideration with a request to the Chair, 

Departmental Appeals Board, within 30 days after receipt of the 

disallowance letter, which must include--

    (i) A copy of the disallowance letter;

    (ii) A statement of the amount in dispute; and

    (iii) A brief statement of why the disallowance is wrong.

    (c) Reconsideration procedures. The reconsideration procedures are 

those set forth in 45 CFR part 16.

    (d) Implementation of decisions. If the reconsideration decision 

requires an adjustment of FFP, either upward or downward, a subsequent 

grant award promptly reflects the amount of increase or decrease.