Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter III - Allowances for Services
Section 144-101-III-107 - Principles of Reimbursement for Psychiatric Residential Treatment Facility Services
Subsection 144-101-III-107-13 - FINANCIAL REPORTING
Universal Citation: 10 ME Code Rules ยง 144-101-III-107-13
Current through 2024-38, September 18, 2024
13.1 MASTER 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.
13.2 UNIFORM 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.
13.3 ADEQUACY 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).
13.4 REVIEW 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.
13.5 SETTLEMENT 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.
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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