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prospective payment rate is incorrect;

(3) specify the relief requested;

(4) provide a name, address, telephone number, and other contact information for the facility representative designated as the point of contact for the appeal; and

(5) include a certificate showing the date the appeal was mailed or electronically delivered. (b) If a request for reconsideration under 7 AAC 150.210(b) is denied, or if a facility is aggrieved by a decision on reconsideration under 7 AAC 150.210(b), the facility may file a written notice of appeal with the commissioner not later than 30 days after the date the denial or decision is mailed or electronically delivered. In the notice of appeal, the facility must

(1) set out a statement of issues;

(2) identify the basis for the facility’s contention that the written determination of the prospective payment rate is incorrect;

(3) specify the relief requested;

(4) provide a name, address, telephone number, and other contact information for the facility representative designated as the point of contact for the appeal; and

(5) include a certificate showing the date the appeal was mailed or electronically delivered. (c) If a decision on a prospective payment rate is appealed to the commissioner, that rate will be effective subject to adjustment based on the commissioner’s decision on the administrative appeal. (d) A notice of appeal under (a) or (b) of this section must be filed at the office of the commissioner in Juneau, and a copy must be sent to the Anchorage office of the department with the staff that oversees Medicaid payment rates. (e) The commissioner will deny an administrative appeal as untimely if not filed within the time limits set out in this section. (Eff. 2/1/2010, Register 193; am 1/1/2024, Register 248) Statutory Authority: Authority: AS 47.05.010 AS 47.07.070 AS 47.07.075 Editor’s note: