| (a) Types of Exemptions.
(1) Exemption as an exempted provider. All health care
facilities except those owned by the federal government shall submit
discharge reports to the department unless the department determines
that the hospital shall be considered an exempted provider. The department
shall make a determination of which health care facilities are entitled
to this exemption and shall notify hospitals by email or by regular
United States mail. This exemption, if granted, may be revoked by
the department should the hospital cease to meet the criteria for
exemption. Health care facilities that cease to be exempted as an
exempted provider shall be responsible for submitting discharge claims
on all discharges that occur 30 days after loss of the exemption.
The initial discharge report shall not be due until 90 days after
notice is given. Subsequent discharge reports are due as specified
in §421.3(a) of this title (relating to Schedule for Filing Discharge
Reports).
(2) Exemptions from Quarterly Filing of Discharge Reports.
Health care facilities that wish to submit discharge reports to the
department more often than quarterly may do so by requesting an exemption
to the standard submission schedule. The department may also issue
general exemptions based on the processing arrangements for data collection.
Exemption requests meeting the following criteria as shown in subparagraphs
(A) - (D) of this paragraph will normally be approved.
(A) The exemption request includes the specific schedule
on which the health care facility will make its discharge reports,
which will usually be daily, weekly or monthly.
(B) The exemption request states the medium in which
submissions will be made.
(C) The exemption request will not result in data on
any discharge being submitted to the department at a later date than
it would have been if the standard schedule had been followed.
(D) The health care facility agrees to adhere to the
schedule specified in the exemption request until the health care
facility notifies the department in writing that it wishes to end
the exemption and report according to the standard schedule, or until
a new exemption letter is issued.
(b) Requests for exemptions shall be submitted and
processed using the following procedures as shown in paragraphs (1)
- (4) of this subsection.
(1) A health care facility requesting an exemption
shall submit to the department a letter requesting the exemption and
providing all information necessary to establish the hospital's entitlement
to the exemption. The exemption request shall be signed by the chief
executive officer of the hospital who shall certify that all information
contained in the request is true and correct.
(2) The department shall review the request for exemption.
The department may request additional information from the health
care facility relevant to the exemption request. Within 30 days of
receipt of a request, the department shall issue a letter granting
or denying the exemption. If denied, the letter shall state in detail
the reasons for the denial.
(3) If the department denies an exemption request the
health care facility may:
(A) resubmit the request along with any additional
information or analysis the health care facility deems relevant to
the department. The resubmission shall be considered in the same manner
as an initial submission; or
(B) appeal the department's decision to the commissioner
of the department. The health care facility may make an appeal directly
to the commissioner of the department. In making its determination,
the department will consider only those facts and issues which have
been previously presented to the department.
(4) The department may revoke any type of exemption
if facts indicate that a health care facility no longer meets the
criteria required for an exemption. The department shall give the
health care facility written notice of the revocation at least 30
days prior to the effective date of the revocation. The notice shall
include a detailed statement of the facts on which the revocation
is based. A health care facility may challenge the revocation of its
exemption by:
(A) requesting the department to reconsider the revocation
by submitting any information or analysis the health care facility
deems relevant to the department in writing at least ten days prior
to the effective date of the revocation; and
(B) by appealing to the commissioner of the department
if the department does not grant the request for reconsideration.
In making its determination, the commissioner of the department will
consider only those facts and issues which have been previously presented
to the department.
(c) Reporting loss of exemptions. Health care facilities
shall notify the department in writing within 30 days of their loss
of an exemption authorized by subsection (a) of this section.
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