C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-67, subsec. 144-101-III-67-13

Current through 2024-44, October 30, 2024

Subsection 144-101-III-67-13 - 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 nursing facility; 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 per diem rate described in Principle 37 of these Principles.

13.2COST REPORTS

13.2.1 All long-term care facilities 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 nursing facility determines from the as filed cost report that the nursing facility 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. *If it is determined that the Department owes the facility money, the Department must reimburse at least seventy-five percent (75%) of the as-filed settlement pursuant to the facility's cost reports within ninety (90) days of receipt.

*The Department shall submit to CMS and anticipates approval for a State Plan Amendment related to these provisions.

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

13.2.3 Each long-term care facility 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 long-term care facility can submit a copy of the cost report on a computer disk. 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. The cost report shall also include a calculation of the private pay rate for semi-private rooms. Failure to submit a cost report in the time prescribed above may result in the Department imposing the deficiency per diem rate described in Principle 37.

13.2.4Certification 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 Most recently filed Medicare Cost Report (if a participant in the Medicare Program);

13.2.6.3 Reconciliation of the financial statements to the cost report;

13.2.6.4 Adjusted trial balance;

13.2.6.5 Year-end adjusting entries;

13.2.6.7 Payroll records to include the IRS Quarterly Form 941s, IRS Form 940, Maine Quarterly Form 941MEs, and Maine Quarterly Form ME UC-1s;

13.2.6.8 Depreciation schedule, along with an asset additions and deletions listing;

13.2.6.9 Amortization schedules;

13.2.6.10 Notes payable listing along with copies of new loan agreements and copies of beginning and ending bank statements for each loan;

13.2.6.11 Lease agreements, along with cost of ownership information;

13.2.6.12 Equipment rental general ledger detail and supporting invoices;

13.2.6.13 Real estate and personal property tax bills;

13.2.6.14 Insurance policy cover page(s);

13.2.6.15 Annual home office financial statement and cost allocation workpaper;

13.2.6.16 Organizational chart;

13.2.6.17 Monthly census logs;

13.2.6.18 Personal use information;

13.2.6.19 Revenue Reconciliation;

13.2.6.20 Accounts payable aging schedule;

13.2.6.21 Related party financial statements, trial balances, adjusting entries, and workpaper to support costs incurred and reported on the MaineCare cost report;

13.2.6.22 Monthly Maine Revenue Services Health Care Provider Tax returns and reconciliation;

13.2.6.23 Water and Sewer general ledger detail;

13.2.6.24 Department required prior approvals; and

13.2.6.25 Any other financial information requested by the Department.

13.2.7 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 AND AUDITS OF COST REPORTS BY THE DIVISION OF AUDIT*

13.4.1Cost Report Reviews and Acceptance

13.4.1.1 The Division of Audit shall perform a review on each cost report submitted for acceptance.

13.4.1.2 The review is an analysis of the provider's cost report to determine the adequacy and completeness of the report, including the adequacy and completeness of all supporting documentation required to be filed with the cost report, to identify any amounts due the Department per the cost report, and to determine if the cost report is acceptable.

13.4.1.3 The acceptance review should be completed within 45 days of receipt of the cost report. The Division of Audit will reject any cost report that is not complete and will require the provider to correct any issues identified in the acceptance process. The acceptance review will start again once the corrected information has been submitted.

13.4.2Audits

13.4.2.1 The Division of Audit will perform audits, of the provider's financial and statistical records and systems to determine allowability of costs and final settlement. An audit may include one or more requests for additional documentation from the provider or one or more visits to the Provider's physical location to review documents and records.

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.

*The Department shall submit to CMS and anticipates approval for a State Plan Amendment related to these provisions.

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-67, subsec. 144-101-III-67-13