Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.10 - Nursing Facility Services
Section 10.09.10.14-1 - Desk Reviews and Field Verification for Rates Effective January 1, 2015
Universal Citation: MD Code Reg 10.09.10.14-1
Current through Register Vol. 51, No. 19, September 20, 2024
A. Desk Reviews.
(1) The Department or its designee
may conduct a desk review of the costs before establishing the Administrative
and Routine and Other Patient Care prices and Nursing Service rates.
(2) The Department or its designee shall
notify each provider participating in the Program if any adjustments resulted
from the desk review.
(3) Desk
review adjustments shall be used in the computation of any future rate for the
facility or the facility's future owner that is based on the reported or desk
reviewed costs, until the rate is rebased.
B. Field Verifications.
(1) The Department or its designee may
conduct a field verification of the reported or desk reviewed costs affecting
reimbursement rates.
(2) The
Department or its designee shall notify each provider participating in the
Program of the results of the field verification.
(3) Field audit adjustments shall be used in
the computation of any future rate for the facility or the facility's future
owner that is based on the reported or desk reviewed costs, until the rate is
rebased.
(4) Field audit
adjustments shall be used in the recomputation of any past rate for the
facility or the facility's past owner that is based on the reported or desk
reviewed costs.
(5) If the
recomputation of rates results in a rate that differs more than 2 percent from
the initial rate computation excluding the quality assessment, the Department
shall initiate an adjustment for the impacted service dates within 60 days
after the notification described in §B(2) of this regulation.
(6) Field audit adjustments shall only affect
the facility's rates and do not affect prices or rates for other facilities
within the geographic region.
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