Ala. Admin. Code r. 560-X-36-.07
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-36-.07 - Financial Accountability Of Operating Agencies(1) The financial accountability of providers for funds expended on home- and community-based services must be maintained and provide a clearly defined audit trail. Providers must retain records that fully disclose the extent and cost of services provided to eligible recipients for a five-year period. These records must be accessible to the Alabama Medicaid Agency and appropriate state and federal officials. If these records are not available within the state of Alabama, the provider will pay the travel cost of the auditors.(2) The state agencies as specified in the approved waiver document as operating agencies of home- and community-based services, will have their records audited at least annually at the discretion of the Alabama Medicaid Agency. Payments that exceed actual allowable cost will be recovered by Medicaid.(3) The Alabama Medicaid Agency will review at least annually the recipient's care plans and services rendered by a sampling procedure. The review will include appropriateness of care and proper billing procedures.(4) The state agencies as specified in the approved waiver document will provide documentation of actual costs of services and administration. Such documentation will be entitled "Quarterly Cost Report for the Elderly and Disabled Waiver." The "Quarterly Cost Report" will include all actual costs incurred by the operating agency for the previous quarter and include costs incurred year-to-date. This documentation will be submitted to the Alabama Medicaid Agency before the first day of the third month of the next quarter. Quarters are defined as follows: (a) 1st October - December | Due before March 1 |
(b) 2nd January - March | Due before June 1 |
(c) 3rd April - June | Due before September 1 |
(d) 4th June - September | Due before December 1 |
Failure to submit the actual cost documentation can result in the Alabama Medicaid Agency deferring payment until this documentation has been received and reviewed. Quarterly Cost Reports will be reviewed to determine necessity of a field audit.
(5) Auditing Standards - Office of Management and Budget (OMB) Circular A-87, "Cost Principles for State and Local Governments" will apply to governmental agencies participating in this program. For nongovernmental agencies, generally accepted accounting principles will apply. Governmental and nongovernmental agencies will utilize the accrual method of accounting unless otherwise authorized by the Alabama Medicaid Agency.(6) Cost, Allowable and Unallowable -- (a) 45 CFR, Part 95, specifies dollar limits and accounting principles for the purchase of equipment. Purchases above the twenty-five thousand dollar limit require the approval of Medicaid.(b) OMB Circular A-87 establishes cost principles for governmental agencies and will act as a guide for non-governmental agencies. For governmental agencies, all reported cost will be adjusted to actual cost at the end of the fiscal year.(c) Contract payments for the delivery of the specific services are allowable expenses. Thus, contracts for case management, personal care, homemaker, respite care, adult day health, and home delivered meals are recognized expenses. All other contracts will require Medicaid approval to ensure that functions are not being duplicated. For example, outreach is to be performed by the case manager, thus, it would not be appropriate to approve other contracts for outreach, unless it can be clearly shown that the function is required and cannot be provided within the established organization.(d) Allowable costs are defined in OMB Circular A-87. However, the following restrictions apply: 1. Advertising is recognized only for recruitment of personnel, solicitation of bids for services or goods, and disposal of scrap or surplus. The cost must be reasonable and appropriate.2. The cost of buildings and equipment is recognized. For governmental agencies, buildings and equipment exceeding twenty-five thousand dollars will be capitalized in accordance with 4 5 CFR §95.705 and depreciated through a use allowance of two percent of acquisition cost for building and six and two-thirds percent for equipment. Equipment that has a remaining value at the completion of the project will be accounted for in accordance with 4 5 CFR §95.707 . For automated data processing equipment, see 4 5 CFR §95.641 . When approval is required, the request will be made to the Medicaid Agency in writing.3. The acquisition of transportation equipment will require prior approval from the Alabama Medicaid Agency. When approval is required, the request will be made to Medicaid in writing.4. Transportation is an allowable expense to be reimbursed as follows: (i) For nongovernmental agencies, it will be considered as part of the contract rate.(ii) For government and private automobiles utilized by state employees, reimbursement will be made at no more than the current approved state rate.(iii) All other types of transportation cost will be supported by documents authorizing the travel and validating the payment.(e) Unallowable costs are specified in OMB Circular A-87. In addition to these, the following are not covered by this program:1. Cost covered by other programs, such as: (v) Inhalation, group, speech, occupational, and physical therapy.2. The cost of advisory councils or consultants without the Alabama Medicaid agency's approval.3. Legal fees as follows: (ii) Relating to fair hearing,(iii) In connection with lawsuits, which result in an adverse decision,(iv) Services that duplicate functions performed by Medicaid or the provider, such as eligibility determination for the program,(v) Other legal fees not relating to the providing of services to the beneficiaries.4. Dues and subscriptions not related to the specific services.(7) Cost Allocation Plans (a) State agencies are required to have a cost allocation plan approved by the Division of Cost Allocation (DCA) when the agencies handle multiple federal funds. The format of a cost allocation plan is specified by 4 5 CFR §95.507, which also calls for written agreements between state agencies. Existence of such a plan will be an item of audit.(b) Direct costs are charged to the specific services that incurred them. It is the indirect/overhead costs that are allocated to the specific fund. If there is more than one project within a fund, there must be a written plan to distribute fund costs among the projects. Within this project, there are two types of indirect costs. The first are those that can be associated with the services that are provided, such as an assessment at the central office that verifies the quality of service. This cost can be prorated to each service by some method that is described in writing. This first type of cost qualifies for the federal match benefit percentage. The second type of allocated cost falls under the administration definition. For example, a mail distribution clerk that distributes to all programs. This second type has a federal match of 50/50; therefore, both types must be accounted for separately.(c) Contracts which are used for procuring services from other governmental agencies must be cost-allocated. As a minimum, these contracts should meet requirements of 4 5 CFR §95.507 ; these contracts must indicate: 1. "The specific services being purchased."2. "The basis upon which the billing will be made --(e.g., time reports, number of homes inspected, etc.)."3. "A stipulation that the billing will be based on actual cost incurred." This is not a requirement for nongovernmental agencies. For governmental agencies, the billing should be either actual cost or an agreed upon fixed fee approximating actual cost which will be adjusted to actual cost at completion of the fiscal year.Ala. Admin. Code r. 560-X-36-.07
Emergency rule effective march 18, 1985. Permanent rule effective July 13, 1985. Amended: effective November 18, 1987, June 6, 1990. Amended: Filed August 7, 1995; effective September 12, 1995. Amended: Filed June 11, 2003; effective July 16, 2003. Amended: Filed April 11, 2008; effective May 16, 2008. Amended: Filed September 11, 2008; effective October 16, 2008. Amended: Filed June 12, 2012; effective July 17, 2012.Author: Monica Abron, Associate Director, LTC Program Management Unit
Statutory Authority: 42 CFR Part 441 ; 45 CFR §95 ; OMB Circular A-87, Subpart G; The Home-and Community-Based Waiver for the Elderly and Disabled.