Oregon Administrative Rules
Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES
Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES
Section 309-015-0050 - Auditing

Universal Citation: OR Admin Rules 309-015-0050

Current through Register Vol. 63, No. 9, September 1, 2024

(1) Desk review of annual Medicaid cost report. The Medicaid intermediary will analyze by desk review each annual Medicaid cost report after it has been properly completed and filed.

(2) Scope of desk review. The scope of the desk review will verify, to the extent possible:

(a) That the provider has properly included its allowable costs on the annual Medicaid cost report on the basis of generally accepted accounting principles and the provisions of these rules;

(b) That the provider has properly applied the cost finding method specified by the Medicaid Intermediary to its allowable costs determined in subsection (a) of this section; and

(c) Whether or not the analysis indicates that further auditing of the provider's financial and statistical records is needed.

(3) Allowable costs. The costs considered allowable may include part or all of the following (worksheet form numbers are correct as of the effective date of this rule):

(a) The costs stated as final values on Worksheet B, HCFA-2552, Cost Allocation for General Services Costs;

(b) Physician costs as determined by completing Worksheet A-8-2, HCFA-2552;

(c) Return on equity as determined by completing the applicable portions of Worksheet F, HCFA-2552.

(4) Ownership changes. Payments to providers shall not be increased, solely as a result of a change of ownership, in excess of the increase which would result from applying Section 1861(v)(1)(O) of the Social Security Act as applied to owners of record on or after July 18, 1984.

(5) Field audit. All filed annual Medicaid cost reports are subject to a field audit.

(6) Scope of field audit. The scope of the field audit will, at a minimum, be sufficiently comprehensive to verify that in all material respects:

(a) Generally accepted accounting principles and the provisions of these rules have been adhered to;

(b) Reported data is in agreement with supporting records; and

(c) The report is reconcilable to the appropriate Medicare report, federal tax return, and payroll tax reports.

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.025 & 414.065

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