Decision Review

The Decision Review Process is only for providers that receive a Final Repayment Notice based on a HRSA finding of non-compliance or the results of a HRSA audit/assessment with monetary findings. Providers that would like to dispute HRSA's request for repayment can request a Decision Review via the Decision Review Portal.

Please refer to the Decision Review Portal User Guide (PDF - 678 KB) for additional direction in submitting your request.

How to submit a Decision Review Request

Providers will receive a Final Repayment Notice, which contains the repayment amount and the reason HRSA is requesting repayment of funds.

Providers who disagree with the repayment have an opportunity to request a review of HRSA's decision to recover Provider Relief Fund (PRF), Uninsured Program (UIP), or Coverage Assistance Fund (CAF) payment(s) by taking the following steps:

1. Review the Final Repayment Notice sent by HRSA which contains important information needed for the Decision Review Process including:
   1. Reason for non-compliance
   2. Last three digits of Tax ID Number (TIN)
   3. Repayment ID
   4. Repayment amount
   5. Web address for the Decision Review Portal

   Repayment IDs

   Each repayment request corresponds to a single amount to be returned by a provider.

   Each repayment amount is eligible for a Decision Review and will have its own unique Repayment ID.

   • The Decision Review Portal prompts providers to submit the Tax Identification Number, Repayment ID, and repayment amount for the repayment request to which they are requesting a Decision Review.
   • Providers may have received more than one payment for which HRSA is seeking repayment. For example, providers may have failed to report on multiple payments received. Providers must complete a separate submission for each Repayment ID that is identified in the Final Repayment Notice. Decision Review Requests cannot be combined.
   • Providers are unable to submit duplicate submissions for a Repayment ID. Once a Repayment ID has been used in a submitted Decision Review Request, that ID cannot be re-used.

   Providers selected for audits and assessments

   Providers selected for an audit/assessment will receive an audit/assessment report along with a cover letter. If there are monetary findings that the provider would like to dispute, the cover letter will include a Repayment ID and the provider will have an opportunity to submit a Decision Review Request via the Decision Review Portal within 60 days from the date of the cover letter.

   If monetary findings are upheld following HRSA's review, the provider will receive a Final Repayment Notice outlining steps for providers to return funds. Providers will not be given another opportunity to request Decision Review at this stage.

   Results of a Decision Review that support the initial determination may be referred to the PSC for debt collection.

   Documentation

   Providers can submit documentation in the Decision Review Portal related to the (1) reason payments must be returned or (2) the amount HRSA has indicated must be repaid.

   • The Decision Review Portal only supports Microsoft Excel and Adobe PDF formats.
   • There is a combined file limit of 25 MB per submission. The Portal does not accept submissions that exceed the file limit.
   • Providers cannot upload additional documentation in the Portal after submitting a Decision Review Request, so providers are encouraged to carefully review all documentation before submitting their request.

   Help with decision review

   For additional information about requesting a decision review, or to verify a submission, contact the Decision Review Provider Support Line using the information in the Final Repayment Notice or audit/assessment final report.