Sec.17-311-166. Notification and hearings

(a) The commissioner shall send a notice by mail to each facility, informing the facility of the commissioner's decision with respect to the self-pay charges approved, and the percentage of increase approved for self-pay charges for ancillary services for the prospective fiscal year beginning July 1st. Immediately upon receipt of the self-pay charges decision, each facility shall provide a written notice of the decision to any self-pay patient affected, or to his guardian or conservator. Any facility, self-pay patient, or the guardian or conservator of a self-pay patient, aggrieved by the decision with respect to the self-pay charges, may obtain by request in writing to the commissioner, a hearing with respect to the self-pay charges decision, provided that such written request is made not later than ten (10) days after the date that the written notice of the decision is provided by the commissioner to the facility.

(b) Notices shall be sent by the facility by regular mail, postage prepaid, to the last known address of the self-pay patient, guardian, or conservator, and the facility shall certify to the commissioner the date upon which the notices were mailed to the self-pay patients.

(c) Notices sent by the facility to self-pay patients, guardians, or conservators regarding the self-pay charges established by the commissioner must contain the following information:

(1) The self-pay charge established by the commissioner for the level of care and type of room occupied by the patient.

(2) The date of the decision by the commissioner.

(3) The manner in which the patient, guardian or conservator may contest the self-pay charge, i.e., by mailing to the commissioner a written request for a hearing within ten days of the date of the decision by the commissioner.

(4) The address of the commissioner.

(d) Upon the receipt of a request for a hearing with respect to the self-pay charges, the Commissioner shall schedule a hearing in accordance with the provisions of sections 4-177 to 4-181, inclusive, and in accordance with section 17-311-27 through 17-311-40 of the rules of practice of the Commissioner. The hearing shall be held as soon as practicable after the receipt of such request by the Commissioner. The Commissioner shall provide notice to the facility of the date, time and place of the self-pay rate hearing. The facility must provide written notice, postage prepaid, of such date, time and place of the self-pay hearing to the last known address of any self-pay patient affected or to his guardian or conservator. The facility must also conspicuously post such notice on its premises. Failure of the facility to provide such notice to its self-pay patients shall constitute cause for a default of the facility at the self-pay rate hearing.

(e) The Commmissioner shall proceed with reasonable dispatch to conclude the hearing pending before him with respect to the establishment of the self-pay charges and shall render final decision not later than ninety days following the close of the hearing, the filing of the briefs, the filing of late file exhibits, or the receipt by the department of the hearing transcript, whichever last occurs.

(f) Pursuant to any hearing with respect to self-pay charges requested by a patient, guardian, or conservator, the facility, pending receipt of the commissioner's final decision, shall be permitted to charge and collect any amounts equal to or less than the self-pay charges established by the commissioner. If the present self-pay charge is greater than the self-pay charge established by the commissioner for the prior fiscal year, the facility shall escrow 20% of the difference, of the aggrieved patient's charges.

(g) Any final decision rendered by the commissioner pursuant to any hearing with respect to establishing self-pay charges requested by a patient, guardian or conservator, shall apply to all other similarly situated self-pay patients.

(Effective June 2, 1986)