10-144-101 Me. Code R. § III-97-E-3400

Current through 2024-44, October 30, 2024
Section 144-101-III-97-E-3400 - SETTLEMENT OF COST REPORTS
3400.1 Uniform Desk Review
3400.1.1 The Division of Audit shall perform a uniform desk review of each acceptable cost report submitted.
3400.1.2 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, and allowable costs.
3400.1.3 Based on the results of the uniform desk review, the Division of Audit shall:
1. Request more information
2. Issue a final settlement, or
3. Conduct a field audit and issue a final settlement.
3400.2 Calculation of Final Settlement
3400.2.1 The total actual costs of the facility shall be determined in accordance with Section 2400 in Chapter III and this Appendix.
3400.2.2 The total cost cap approved in the facility budget shall be determined in accordance with Section 6000 of this Appendix.
3400.2.3 The allowable cost shall be limited to the lesser of the total actual cost of the facility, which includes the State-mandated service tax, or the sum of the total cost cap approved in the facility budget plus the State-mandated service tax and program allowance on the service tax.
3400.2.4 To determine the allowable cost per bed day, the allowable cost shall be divided by the total actual days of care.
3400.2.5 The allowable cost per bed day shall be multiplied by MaineCare eligible days to determine the reimbursable MaineCare cost.
3400.2.6 Final settlement: The reimbursable MaineCare cost, determined through the audit, shall be compared to the interim payments to determine an overpayment or underpayment.

10-144 C.M.R. ch. 101, § III-97-E-3400