Ala. Admin. Code r. 560-X-60-.13

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-60-.13 - Cost Reports

(1) General - Cost report filing, using Medicaid prescribed cost report forms, is mandatory for new PBRHCs when (1) submitting an operating budget to establish a budget rate and

(2) submitting actual cost to settle the budgeted period. Each new PBRHC will have its own National Provider Identification (NPI) number and file its own cost report. This means that if a provider has five clinics, each with its own Medicare number, five cost reports should be filed using five different NPI numbers.

(2) Cost Report (New PBRHCs) - Each new PBRHC is required to file a complete cost report after the budget period ends. The PBRHC fiscal year-end must be the same as the affiliated provider; i.e., hospital, nursing facility, home health agency, etc. This is because you must show the allocation of costs to the PBRHC through a step-down procedure. If an affiliated provider has five clinics, costs must be step-down separately to the five individual clinics. If a clinic is a part of a hospital, the hospital cannot file an abbreviated hospital cost report. The hospital cost report must contain all schedules and attachments. The PBRHC cost report is due 90 days after the fiscal year end.

(3) Cost Report Filing - Two copies of the cost report must be received by Medicaid by the due date given in correspondence to the provider. Each copy will have an original signature of the administrator or an officer of the PBRHC. The signature must be preceded by the following certification: I HEREBY CERTIFY that I have examined the accompanying worksheets prepared by ______________________ for the reporting period beginning ________________________ and ending ____________________ and that to the best of my knowledge and belief it is a true, correct and complete statement prepared from the books and records of the PBRHC in accordance with applicable instructions, except as noted.

___________________________________

Signature (Officer or Administrator) Title Date

Any cost report received by Medicaid without the required original signature and/or without the required certification will be deemed incomplete and returned to the provider.

(4) Extensions. Cost reports shall be prepared with due diligence and care to prevent the necessity for later submittals of corrected or supplemental information by the PBRHC. Extensions may be granted only upon written approval by Medicaid for good cause shown. An extension request must be in writing, contain the reasons for the extension, and must be made prior to the cost report due date. Only one extension, for a maximum of 30 days, will be granted by the Agency.

(5) Penalties. If a complete cost report is not filed by the due date, or an extension is not requested or granted, the provider shall be charged a penalty of $100.00 per day for each calendar day after the due date. This penalty will not be a reimbursable Medicaid cost. The Commissioner of Medicaid may waive such penalty for good cause shown. Such showing must be made in writing to the Commissioner with supporting documentation. Once a cost report is late, Medicaid shall suspend payments to the provider until the cost report is received. A cost report that is over 90 days late may result in suspension of the provider from the Medicaid program. Further, the entire amount paid to the provider during the fiscal period with respect to which the report has not been filed will be deemed an overpayment. The provider will have 30 days to either refund the overpayment or file the delinquent cost report after which time Medicaid may institute a suit or other action to collect this overpayment amount or the delinquent cost report.

(6) Cost reports will be deemed immutable with respect to the reimbursement for which the provider is entitled for the next succeeding fiscal year, one year from the date of its receipt by Medicaid, or its due date, whichever is later. Providers will have this one year period within which to resubmit their cost reports for the purpose of correcting any material errors or omissions of fact. This one year limitation does not apply to adjustments in cost reports that are initiated by Medicaid. Medicaid retains the right to make adjustments in cost reports at any time a material error or omission of fact is discovered.

(7) Providers, who terminate their participation in the Medicaid program, by whatever means, must provide a written notice to the Agency 30 days in advance of such action. Failure to provide this written notice shall result in a $100.00 per day penalty being assessed for each day short of the 30 days' advance notice period (up to a maximum of $3,000.00). Terminating providers must file a final cost report within 75 days of terminating their participation in the program. Final payment will not be made by the Medicaid Agency until this report is received. Failure to file this final cost report will result in Medicaid deeming all payments covered by the cost report period as overpayments until the report is received. Additionally, a penalty of $100.00 will be assessed for each calendar day that the cost report is late.

Ala. Admin. Code r. 560-X-60-.13

Emergency rule effective October 1, 1993. New Rule: Filed December 7, 1993; effective January 12, 1994. Amended: Filed November 12, 2008; effective December 17, 2008.

Author: Sandra Johnson, Associate Director, Provider Audit, Q/A Reimbursement

Statutory Authority:Code of Alabama 1975, State Plan; Title XIX, Social Security Act, 42 C.F.R. Sections 405.2460 - .2472 and 447.371.