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-67 - Principles of Reimbursement for Nursing Facilities
Subsection 144-101-III-67-13 - FINANCIAL REPORTING
Universal Citation: 10 ME Code Rules ยง 144-101-III-67-13
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 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.
13.2 COST 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.
13.2.2
Forms. 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.
13.2.4
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 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.
13.3 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 AND AUDITS OF COST REPORTS BY THE DIVISION OF AUDIT*
13.4.1
Cost 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.
13.4.2
Audits
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.
13.5 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.
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