Current through Register Vol. 24-18, September 15, 2024
(1) For patients discharged after June 30,
2005, a certified public expenditure (CPE) hospital must annually submit to the
medicaid agency federally required medicaid cost report schedules, using
schedules approved by the centers for medicare and medicaid services (CMS),
that apportion inpatient and outpatient costs to medicaid clients and uninsured
patients for the service year, as follows:
(a)
Title XIX fee-for-service claims;
(b) Medicaid managed care organization (MCO)
plan claims;
(c) Uninsured
patients. The cost report schedules for uninsured patients must not include
services that medicaid would not have covered had the patients been medicaid
eligible (see WAC
182-550-1400 and
182-550-1500); and
(d)State-administered program patients.
State-administered program patients are reported separately and are not to be
included on the uninsured patient cost report schedule. The agency will provide
provider statistics and reimbursements (PS&R) reports for the
state-administered program claims.
(2)A CPE hospital must:
(a)Use the information on individualized
PS&R reports provided by the agency when completing the medicaid cost
report schedules. The agency provides the hospital with the PS&R reports at
least thirty calendar days before the appropriate deadline.
(i) For state fiscal year (SFY) 2006, the
deadline for all CPE hospitals to submit the federally required medicaid cost
report schedules is June 30, 2007.
(ii) For hospitals with a December 31 year
end, partial year medicaid cost report schedules for the period July 1, 2005
through December 31, 2005 must be submitted to the agency by August 31,
2007.
(iii) For SFY 2007 and
thereafter, each CPE hospital must submit the medicaid cost report schedules to
the agency within thirty calendar days after the medicare cost report is due to
its medicare fiscal intermediary or medicare administrative contractor,
whichever applies.
(b)
Complete the cost report schedules for uninsured patients and medicaid clients
enrolled in an MCO plan using the hospital provider's records.
(c) Comply with the agency's instructions
regarding how to complete the required medicaid cost report
schedules.
(3) The
medicaid cost report schedules must be completed using the medicare cost report
for the same reporting year.
(a) The ratios of
costs-to-charges and per diem costs from the "as filed" medicare cost report
are used to allocate the medicaid and uninsured costs on the "as filed"
medicaid cost report schedules, unless expressly allowed for
medicaid.
(b) After the medicare
cost report is finalized by the medicare fiscal intermediary or medicare
administrative contractor (whichever applies), final medicaid cost report
schedules must be submitted to the agency incorporating the adjustments to the
medicare cost report, unless expressly allowed for medicaid. CPE hospitals must
submit finalized medicare cost reports with the notice of amount of program
reimbursement (NPR) within thirty calendar days of receipt. The agency will
then provide the hospitals with updated PS&R reports for medic-aid and
state program claims processed by the agency for the medicaid cost report
period. The hospitals will update the data for uninsured patients and medicaid
clients enrolled in an MCO plan.
(4) The medicaid cost report schedules and
supporting documentation are subject to audit by the agency or its designee to
verify that claimed costs qualify under federal and state rules governing the
CPE payment program. The documentation required includes, but is not limited
to:
(a)The revenue codes assigned to specific
cost centers on the medicaid cost report schedules.
(b)The inpatient charges by revenue codes for
uninsured patients and medicaid clients enrolled in an MCO plan.
(c) The outpatient charges by revenue codes
for uninsured patients and medicaid clients enrolled in an MCO plan.
(d) All payments received for the inpatient
and outpatient charges in (b) and (c) of this subsection including, but not
limited to, payments for third party liability, uninsured patients, and
medicaid clients enrolled in an MCO plan.
(5)The agency:
(a)Performs cost settlements for both the "as
filed" and "final" medicaid cost report schedules for all CPE
hospitals;
(b) Reports to CMS as an
adjustment any difference between the payments of federal funds made to the CPE
hospitals and the federal share of the certified public expenditures;
and
(c)Recoups from the CPE
hospitals the federal payments that exceed the hospitals' costs, unless the
hold harmless provision in WAC
182-550-4670 applies.
11-14-075, recodified as §182-550-5410, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090 and
74.09.500. 08-20-032, §
388-550-5410, filed 9/22/08, effective 10/23/08; 07-14-090, §
388-550-5410, filed 6/29/07, effective
8/1/07.
