Subsection 144-101-III-67-25 - FINAL AUDIT OF FIRST AND SUBSEQUENT PROSPECTIVE YEARS25.1Principle. All facilities will be required to submit a cost report in accordance with Principle 13.2 at the end of their fiscal year on cost report forms approved by the Department. The Department will conduct a final audit of each facility's cost report, which may consist of a full scope examination by Department personnel and which will be conducted on an annual basis. 25.2 Upon final audit of a facility's cost report for the first and subsequent prospective years, the Department will: 25.2.1 Determine the actual allowable fixed costs incurred by the facility during the cost reporting period,25.2.2 Determine the occupancy levels of the nursing facility,25.2.3 Determine reimbursable direct care costs incurred by the facility during the reporting period per Principle 22.3.4.4.25.2.4 Determine the actual allowable routine costs incurred by the facility during the cost reporting period per Principle 22.4.6.25.2.5 Determine if the payment criteria as described in 18.12 has been met.25.2.6 Calculate a final rate.25.2.7 Determine final settlement by calculating the difference between the audited final rate and the interim rate(s) paid to the provider times the MaineCare utilization. Nursing facilities that transfer a cost center from one (1) cost component to another cost component resulting in increased MaineCare costs will have the affected cost components adjusted at time of audit. Upon final audit of a facility's cost report, the Department will calculate a final prospective rate and determine the lump sum settlement amount either due to or from the nursing facility.
The Division of Audit final audit adjustment to the nursing facility's annual cost report will consider the impact of days waiting placement as specified in the Principles of Reimbursement for Residential Care Facilities. Fixed cost reimbursement for the nursing facility will not be affected by days waiting placement reimbursement to the nursing facilities.
C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-67, subsec. 144-101-III-67-25