Cal. Code Regs. Tit. 22, § 51016 - Definitions
(a) The following
definitions shall be used throughout this article unless otherwise noted.
(1) Audits or Examination Report. "Audit or
examination report" means a document that presents the final audit or
examination findings and is formally issued to the provider by the Department
upon the completion of the audit or examination.
(2) Completed Audit or Examination.
"Completed audit or examination" means an audit or examination for which an
audit or examination report has been issued.
(3) "Date of mailing" means the date
postmarked on the envelope if postage was prepaid and the envelope was properly
addressed.
(4) Demand for
Repayment. "Demand for repayment" means a written notice issued to the provider
by the Department that identifies the amount of the overpayment, determined by
an audit or examination, that must be repaid. The notice may be made through
the issuance of a statement of accountability, statement of account status,
letter, or any combination of the foregoing.
(5) Duplicate. "Duplicate" means a
counterpart or facsimile copy of the original produced by the same impression
or from the same matrix as the original or by some technique of accurate
reproduction.
(6) "Exit conference"
means an informal meeting, between the provider and those Department
representatives responsible for the audit or examination, at which the
preliminary findings of the audit or examination are discussed.
(7) Formal Hearing. "Formal hearing" means an
administrative hearing conducted by a hearing officer pursuant to Section
14171(b),
Welfare and Institutions Code, and the provisions of this article.
(8) Hearing Auditor. "Hearing auditor" means
an individual designated to conduct the informal level of review.
(9) Hearing Officer. "Hearing officer" means
a hearing officer appointed by the Director pursuant to Section
14171(b),
Welfare and Institutions Code.
(10)
Informal Conference. "Informal conference" means a proceeding conducted in
person or by telephone, for the purpose of scheduling the informal level of
review and formal hearing; exchanging documents; and resolving other
preliminary matters.
(11) Informal
Level of Review. "Informal level of review" means an informal hearing for
institutional providers and a pretrial conference for non-institutional
providers, held by a hearing officer or hearing auditor prior to a formal
hearing to clarify or resolve facts and issues in dispute.
(12) Party. "Party" means the provider, the
Department and any person, other than a hearing officer, allowed to appear in
the proceedings.
(13) Institutional
Provider. "Institutional provider" means any of the following:
(A) Any individual, entity or organization of
a type required to be licensed pursuant to either Chapter 1 (commencing with
Section 1200) or Chapter 2 (commencing
with Section
1250) of Division 2, Health and
Safety Code, or exempt from licensure pursuant to Section
1206(b) through
(l) Health and Safety Code, or Section
1254 Health and Safety Code which
provides services or supplies under the Medi-Cal program, and is subject to
audit by the Department.
(B) Any
individual, entity, or organization of a type required to file a cost report or
cost information with the Department.
(14) Non-institutional Provider.
"Non-institutional provider" means any individual, entity, or organization
other than those defined in subsection (13) who provides services or supplies
under the Medi-Cal program, and who is subject to audit by the
Department.
(15) File. "File" means
delivery of a pleading or other paper to, and its date stamping by, the Office
of Administrative Hearings and Appeals, Office of Legal Services, Department of
Health Services.
(16) Serve.
"Serve" means the delivery of a pleading or other paper on a party in the
manner provided by Government Code Section
11505(c).
Notes
2. Repealer of Article 1.5 (Sections 51016-51043) and new Article 1.5 (Sections 51016-51047) filed 5-8-80; effective thirtieth day thereafter (Register 80, No. 19).
3. Amendment filed 10-11-84; effective upon filing pursuant to Government Code Section 11346.2(d) (Register 84, No. 41).
4. Amendment filed 9-17-85; effective thirtieth day thereafter (Register 85, No. 38).
Note: Authority cited: Sections 14105, 14124.5 and 14171, Welfare and Institutions Code. Reference: Sections 14171 and 14172.5, Welfare and Institutions Code.
2. Repealer of Article 1.5 (Sections 51016-51043) and new Article 1.5 (Sections 51016-51047) filed 5-8-80; effective thirtieth day thereafter (Register 80, No. 19).
3. Amendment filed 10-11-84; effective upon filing pursuant to Government Code Section 11346.2(d) (Register 84, No. 41).
4. Amendment filed 9-17-85; effective thirtieth day thereafter (Register 85, No. 38).
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