Current through Register Vol. 18, September 20, 2024
(1) Providers must use generally accepted
accounting principles to record and report costs. The provider must, in
preparing the cost report required under this rule, adjust such costs in
accordance with ARM
37.40.345 to determine allowable
costs.
(2) Providers must use the
accrual method of accounting, except that, for governmental institutions that
operate on a cash method or a modified accrual method, such methods of
accounting will be acceptable.
(3)
Cost finding means the process of allocating and prorating the data derived
from the accounts ordinarily kept by a provider to ascertain the provider's
costs of the various services provided. In preparing cost reports, all
providers must use the methods of cost finding described at
42 CFR
413.24 (1997), which the department hereby
adopts and incorporates herein by reference.
42 CFR
413.24 is a federal regulation setting forth
methods for allocating costs. A copy of the regulation may be obtained from the
Department of Public Health and Human Services, Senior and Long Term Care
Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210. Notwithstanding
the above, distinctions between skilled nursing and nursing facility care need
not be made in cost finding.
(4)
All providers must report allowable costs based upon the provider's fiscal year
and using the financial and statistical report forms designated and/or provided
by the department. Reports must be complete and accurate. Incomplete reports or
reports containing inconsistent data will be returned to the provider for
correction.
(a) A provider must file its cost
report:
(i) within 150 days after the end of
its designated fiscal year;
(ii)
within 150 days after the effective date of a change in provider as defined in
ARM 37.40.325; or
(iii) for changes in providers occurring on
or after July 1, 1993, within 150 days after six months participation in the
Medicaid program for providers with an interim rate established under ARM
37.40.326. Subsequent cost reports
are to be filed in accordance with (4) (a) (i) above and subsequent cost
reports shall not duplicate previous cost reporting periods.
(b) The report forms required by
the department include certain Medicare cost report forms and related
instructions, including but not limited to certain portions of the most recent
version of the CMS-2540 or CMS-2552 cost report forms, as more specifically
identified in the department's cost report instructions. The department also
requires providers to complete and submit certain Medicaid forms, including but
not limited to the most recent version of the Medicaid expense statement, form
DPHHS-MA-008A.
(i) In preparing worksheet A
on the CMS-2540 or CMS-2552 cost report form, providers must report costs in
the worksheet A category that correspond to the category in which the cost is
reportable on the Medicaid expense statement, as designated in the department's
cost report instructions.
(ii) For
purposes of the Medicaid cost report required under this rule, all Medicare and
Medicaid cost report forms must be prepared in accordance with applicable cost
report instructions. Medicare cost report instructions shall apply to Medicare
cost report forms to the extent consistent with Medicaid requirements, but the
Medicaid requirements specified in these rules and the department's Medicaid
cost reporting instructions shall control in the event of a conflict with
Medicare instructions.
(c) If a provider files an incomplete cost
report or reported costs are inconsistent, the department may return the cost
report to the facility for completion or correction, and may withhold payment
as provided in (4) (d).
(d) If a
provider does not file its cost report within 150 days of the end of its fiscal
year, or if a provider files an incomplete cost report, the department may
withhold from payment to the provider an amount equal to 10% of the provider's
total reimbursement for the month following the due date of the report or the
filing of the incomplete report. If the report is overdue or incomplete a
second month, the department may withhold 20% of the provider's total
reimbursement for the following month. For each succeeding month for which the
report is overdue or incomplete, the department may withhold the provider's
entire Medicaid payment for the following month. If the provider fails to file
a complete and accurate cost report within six months after the due date, the
department may recover all amounts paid to the provider by the department for
the fiscal period covered by the cost report. All amounts so withheld will be
payable to the provider upon submission of a complete and accurate cost
report.
(e) The department may
grant a provider one 30-day extension for filing the cost report if the
provider's written request for the extension is received by the department
prior to expiration of the filing deadline and if, based upon the explanation
in the request, the department determines that the delay is
unavoidable.
(f) Cost reports must
be executed by the individual provider, a partner of a partnership provider,
the trustee of a trust provider, or an authorized officer of a corporate
provider. The person executing the reports must sign, under penalties of false
swearing, upon an affirmation that he has examined the report, including
accompanying schedules and statements, and that to the best of his knowledge
and belief, the report is true, correct, and complete, and prepared in
accordance with applicable laws, regulations, rules, policies, and departmental
instructions.
(5) A
provider must maintain records of financial and statistical information which
support cost reports for six years, three months after the date a cost report
is filed, the date the cost report is due, or the date upon which a disputed
cost report is finally settled, whichever is later.
(a) Each provider must maintain, as a
minimum, a chart of accounts, a general ledger and the following supporting
ledgers and journals: revenue, accounts receivable, cash receipts, accounts
payable, cash disbursements, payroll, general journal, resident census records
identifying the level of care of all residents individually, all records
pertaining to private pay residents and resident trust funds.
(b) To support allowable costs, the provider
must make available for audit at the facility all business records of any
related party, including any parent or subsidiary firm, which relate to the
provider under audit. To support allowable costs, the provider must make
available at the facility for audit any owner's or related party's personal
financial records relating to the facility. Any costs not so supported will not
be allowable.
(c) Cost information
and documentation developed by the provider must be complete, accurate and in
sufficient detail to support payments made for services rendered to recipients
and recorded in such a manner to provide a record which is auditable through
the application of reasonable audit procedure. This includes all ledgers,
books, records and original evidence of cost (purchase requisitions, purchase
orders, vouchers, checks, invoices, requisitions for materials, inventories,
labor time cards, payrolls, bases for apportioning costs, etc.) which pertain
to the determination of reasonable cost. The provider must make and maintain
contemporaneous records to support labor costs incurred. Documentation created
after the fact will not be sufficient to support such costs.
(d) The provider must make all of the above
records and documents available at the facility at all reasonable times after
reasonable notice for inspection, review or audit by the department or its
agents, the federal department of health and human services, the Montana
legislative auditor, and other appropriate governmental agencies. Upon refusal
of the provider to make available and allow access to the above records and
documents, the department may recover, as provided in ARM
37.40.347, all payments made by
the department during the provider's fiscal year to which such records
relate.
(6) Department
audit staff may perform a desk review of cost statements or reports and may
conduct on site audits of provider records. Such audits will be conducted in
accordance with audit procedures developed by the department.
(a) Department audit staff may determine
adjustments to cost reports or reported costs through desk review or audit of
cost reports. Department audit staff may conduct a desk review of a cost report
to verify, to the extent possible, that the provider has provided a complete
and accurate report.
(b) Department
audit staff may conduct on site audits of a provider's records, information and
documentation to assure validity of reports, costs and statistical information.
Audits will meet generally accepted auditing standards.
(c) The department shall notify the provider
of any adverse determination resulting from a desk review or audit of a cost
report and the basis for such determination. Failure of the department to
complete a desk review or audit within any particular time shall not entitle
the provider to retain any overpayment discovered at any time.
(d) The department, in accordance with the
provisions of ARM 37.40.347, may collect any overpayment and will reimburse a
provider for any underpayment identified through desk review or
audit.
(7) A provider
aggrieved by an adverse department action may request administrative review and
a fair hearing as provided in ARM
37.5.304,
37.5.305,
37.5.307,
37.5.310,
37.5.311,
37.5.313,
37.5.316,
37.5.322,
37.5.325,
37.5.328,
37.5.331,
37.5.334, and
37.5.337.
53-2-201,
53-6-113,
MCA; IMP,
53-2-201,
53-6-101,
53-6-111,
53-6-113,
MCA;
