<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".14" citation="COMAR 10.09.29.14" title_num="10" subtitle_num="09" chapter_num="29" heading="Field Verification.">
  <paragraph num="A.">
    <text>The Department or its designee shall:</text>
    <paragraph num="(1)">
      <text>Conduct a field verification, at least every 3 years, of the reported costs of each facility participating in the Program, if the amount of the facility's reimbursement would justify the expense of a field verification;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Desk review the reported costs of the facility in those years when a field verification is not conducted;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Notify each provider participating in the Program of the results of the field verification or desk review; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Calculate final settlements by comparing the verified allowable reimbursement to the interim reimbursement.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Appeal Findings.</text>
    <paragraph num="(1)">
      <text>After the Department receives the findings of an appeal filed under Regulation .10 of this chapter, the Department shall determine the amount that is due either to the Program or to the provider, and notify the provider of that amount.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the provider has accepted the determination made under §B(1) of this regulation, and within 60 days after the provider receives the notification under §B(1) of this regulation, the Program shall pay the amount the Department has determined is due the provider, if any.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Subject to the provisions of §B(5) and (6) of this regulation, within 60 days after the provider receives the notification under §B(1) of this regulation, the provider shall pay the amount due the Program, if any.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>After the expiration of the 60-day period in §B(3) of this regulation, the Department may, in addition to the sanctions provided for in Regulation .09 of this chapter, recover the unpaid balance by withholding the amount due from the interim payment which would otherwise be payable to the provider.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If a provider requests a longer payment schedule within 30 days after the provider receives notification of the amount due the Program, the Department may establish, after consultation with the provider, a longer payment schedule.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The Department shall establish a longer payment schedule if, in the Department's reasonable judgment, failure to grant a longer payment schedule would:</text>
      <paragraph num="(a)">
        <text>Result in financial hardship to the provider; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Have an adverse effect on the quality of patient care furnished by the facility.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>