C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-107, subsec. 144-101-III-107-13

Current through 2024-44, October 30, 2024

Subsection 144-101-III-107-13 - FINANCIAL REPORTING

13.1MASTER FILE

The following documents concerning the provider or, where relevant, any entity related to the Provider, will be submitted to the Department at the time that the cost report is filed. Such documents will be updated to reflect any changes on a yearly basis with the filing of a cost report. Such documents shall be used to establish a Master file for each facility in the MaineCare Program:

13.1.1 Copies of the articles of incorporation and bylaws, of partnership agreements of any provider or any entity related to the provider;

13.1.2 Chart of accounts and procedures manual, including procurement standards established pursuant to Principle 6;

13.1.3 Plant layout;

13.1.4 Terms of capital stock and bond issues;

13.1.5 Copies of long-term contracts, including but not limited to leases, pension plans, profit sharing and bonus agreements;

13.1.6 Schedules for amortization of long-term debt and depreciation of plant assets;

13.1.7 Summary of accounting principles, cost allocation plans, and step-down statistics used by the provider;

13.1.8 Related party information on affiliations, and contractual arrangements;

13.1.9 Tax returns of the PRTF; and

13.1.10 Any other documentation requested by the Department for purposes of establishing a rate or conducting an audit.

If any of the items listed in Principle 13.1.1 - 13.1.10 are not submitted in a timely fashion the Department may impose the deficiency routine and fixed costs rate described in Principle 30 of these Principles.

13.2UNIFORM COST REPORTS

13.2.1 All PRTFs are required to submit cost reports as prescribed herein to the State of Maine Department of Health and Human Services, Division of Audit, State House Station 11, Augusta, ME, 04333. Such cost reports shall be based on the fiscal year of the facility. If a PRTF determines from the as filed cost report that the PRTF owes moneys to the Department, a check equal to one hundred percent (100%) of the amount owed to the Department will accompany the cost report. If a check is not received with the cost report the Department may elect to offset the current payments to the facility until the entire amount is collected from the provider.

13.2.2 Forms. Annual report forms shall be provided or approved for use by PRTFs in the State of Maine by the Department of Health and Human Services.

13.2.3 Each PRTF in Maine must submit an annual cost report within five (5) months of the end of each fiscal year on forms prescribed by the Division of Audit. If available, the PRTF can electronically submit a copy of the cost report. The inclusive dates of the reporting year shall be the twelve-month period of each provider's fiscal year, unless advance authorization to submit a report for a lesser period has been granted by the Director of the Division of Audit. Failure to submit a cost report in the time prescribed above may result in the Department imposing the deficiency routine and fixed costs rate described in Principle 30.

13.2.4 Certification by operator. The cost report is to be certified by the owner and administrator of the facility. If the return is prepared by someone other than staff of the facility, the preparer must also sign the report.

13.2.5 The original and one (1) copy of the cost report must be submitted to the Division of Audit. All documents must bear original signatures.

13.2.6 The following supporting documentation is required to be submitted with the cost report:

13.2.6.1 Financial statements;

13.2.6.2 Reconciliation of the financial statements to the cost report;

13.2.6.3 Any other financial information requested by the Department; and

13.2.6.4 Cents are omitted in the preparation of all schedules except when inclusion is required to properly reflect per diem costs or rates.

13.3ADEQUACY AND TIMELINESS OF FILING

13.3.1 The cost report and financial statements for each facility shall be filed not later than five (5) months after the fiscal year end of the provider. When a provider fails to file an acceptable cost report by the due date, the Department may send the provider a notice by certified mail, return receipt requested, advising the provider that all payments are suspended on receipt of the notice until an acceptable cost report is filed. Reimbursement will then be reinstated at the full rate from that time forward but, reimbursement for the suspension period shall be made at the deficiency rate of ninety percent (90%).

13.3.2 The Division of Audit may reject any filing that does not comply with these regulations. In such case, the report shall be deemed not filed, until refiled and in compliance.

13.3.3 Extensions to the filing deadline will only be granted under the regulations stated in the Medicare Provider Reimbursement Manual (HIM-15).

13.4REVIEW OF COST REPORTS BY THE DIVISION OF AUDIT

13.4.1 Uniform Desk Review 13.4.1.1 The Division of Audit shall perform a uniform desk review on each cost report submitted.

13.4.1.2 The uniform desk review is an analysis of the provider's cost report to determine the adequacy and completeness of the report, accuracy and reasonableness of the data recorded thereon, allowable costs and a summary of the results of the review. The Division of Audit will schedule an on-site audit or will prepare a settlement based on the findings determined by the uniform desk review.

13.4.1.3 Unless the Division of Audit intends to schedule an on-site audit or requests additional information from the provider, it shall issue a written summary report of its findings and adjustments upon completion of the uniform desk review.

13.4.2 On-site Audit

13.4.2.1 The Division of Audit will perform on-site audits, as considered appropriate, of the provider's financial and statistical records and systems.

13.4.2.2 The Division of Audit will base its selection of a facility for an on-site audit on factors such as but not limited to: length of time since last audit, changes in facility ownership, management, or organizational structure, random sampling evidence or official complaints of financial irregularities, questions raised in the uniform desk review, failure to file a timely cost report without a satisfactory explanation, and prior experience.

13.4.2.3 The audit scope will be limited so as to avoid duplication of work performed by a facility's independent public accountant, provided such work is adequate to meet the Division of Audit's requirements.

13.4.2.4 Upon completion of an audit, the Division of Audit shall review its draft findings and adjustments with the provider and issue a written summary of such findings.

13.5SETTLEMENT OF COST REPORTS

13.5.1 Cost report determinations and decisions, otherwise final, may be reopened and corrected when the specific requirements set out below are met. The Division of Audit's decision to reopen shall be based on:

(1) new and material evidence submitted by the provider or discovered by the Department; or,

(2) evidence of a clear and obvious material error.

13.5.2 Reopening means an affirmative action taken by the Division of Audit to re-examine the correctness of a determination or decision otherwise final. Such action may only be taken:

13.5.2.1 At the request of either the Department, or a provider within the applicable time period set out in paragraph 13.5.4; and,

13.5.2.2 When the reopening may have a material effect (more than one percent (1%) on the provider's MaineCare rate payments.)

13.5.3 A correction is a revision (adjustment) in the Division of Audit's determination, otherwise final, which is made after a proper re-opening. A correction may be made by the Division of Audit, or the provider may be required to file an amended cost report.

13.5.4 A determination or decision may only be re-opened within three (3) years from the date of notice containing the Division of Audit's determination, or the date of a decision by the Commissioner or a court, except that no time limit shall apply in the event of fraud or misrepresentation.

13.5.5 The Division of Audit may also require or allow an amended cost report any time prior to a final audit settlement to correct material errors detected subsequent to the filing of the original cost report or to comply with applicable standards and regulations. Once a cost report is filed, however, the provider is bound by its elections. The Division of Audit shall not accept an amended cost report to avail the provider of an option it did not originally elect.

C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-107, subsec. 144-101-III-107-13