10A NCAC 22G .0302. REPORTING REQUIREMENTS

(a)  Financial reports shall include the following:

(1)           Budget reports:  Each provider shall include appropriate budget information in its application for an initial rate for a new facility:

(A)          The budget shall reflect the projected annual operating results of each of the two years subsequent to the commencement of operating said facility.

(B)          The budget information used to support the Certificate of Need award shall be provided to the Division of Medical Assistance on or before 30 days prior to the enrollment of said facility by the Medicaid program.

(C)          Budgets are not deemed to be appropriately filed unless they are properly prepared, in accordance with rules established by the Division of Medical Assistance.

(2)           Cost reports:  Each facility that receives payments from the North Carolina Medicaid Program shall prepare and submit a separate annual cost report of its costs, a working trial balance related to reimbursement, and other financial information as requested by the Division of Medical Assistance.  Providers that have an approved combined uniform rate in accordance with Rule .0304 Paragraph (n) of this reimbursement plan shall file a combined cost report that is supported by the individual facility cost reports.  For these providers, the combined cost report shall be filed with the Division of Medical Assistance Audit Section while the individual facility cost reports shall be filed with the Division of Medical Assistance Rate Setting Section.

(A)          The cost report shall cover a 12 month period, from July 1 to the following June 30, unless another time frame is specified by the Division of Medical Assistance.

(i)            A short year cost report shall be filed for facilities certified in the Medicaid program during the year, with the cost report period commencing on the date of certification and ending the following June 30.

(ii)           Short year cost report shall be filed for facilities terminated from the Medicaid program during the year, with the cost report period commencing on July 1 and ending on the date of termination.

(B)          The cost report shall be submitted to the state on or before the September 30 that immediately follows the June 30 year end.  The Division of Medical Assistance may grant an extension of time of up to 30 days for filing the cost report, upon showing of just cause in writing by the provider.  For purposes of this Section, "just cause" is an action that is uncontrollable by the provider, such as tornado, hurricane, strong wind damage, etc.

(C)          For new facilities a cost report shall be submitted for the period beginning with the date of certification and ending on the following June 30.

(D)          The cost report shall be based on the Chart of Accounts specified by the Division of Medical Assistance.  The Chart of Accounts includes a description of each account to be used on the cost report.  The Chart of Accounts shall be distributed to each provider by the Division of Medical Assistance.  This material is available for inspection and copies may be obtained from the Division at 1985 Umstead Drive, Raleigh, North Carolina 27603 at a cost of twenty cents ($0.20) per page.  All costs shall be shown on the cost reports in accordance with rules established by the Division of Medical Assistance.  A cost report that does not meet the requirements of the Division of Medical Assistance is deemed not to be filed.

(E)           Currently filed cost reports shall reflect the decisions and judgments expressed by the Division of Medical Assistance auditors on previous cost reports.

(F)           All related organizations shall file a Medicaid cost statement identifying their costs, adjustments to costs, and allocation of costs along with the ICF‑MR facility's cost report.  A home office, or parent company, shall be recognized as a related organization.  Auditable records to support these costs shall be made available to the Division of Medical Assistance and its designated contract auditors.  Undocumented costs shall be disallowed for Medicaid reimbursement.

(G)          Cost reports shall clearly identify related party transactions.  Failure to do so may result in the related cost being disallowed for Medicaid reimbursement purposes.

(H)          A combined cost report may only be filed for facilities that use the same cost settlement methodology and have a uniform rate, as approved by the Division of Medical Assistance.

(b)  Additional information reporting requirements for facilities shall include, but not be limited to, the following:

(1)           Each facility providing day treatment services shall be required to submit, in conjunction with the cost report, a separate report itemizing the actual expense attributable to the provision of day treatment services and the actual number of client days associated with said expense.

(2)           Each provider operating a facility, upon the request of the Division of Medical Assistance, shall submit statistical data and other information relevant to the administration and operation of said facility.  Such reports shall be submitted within the time frames authorized in the request.

(3)           Each provider that issues an annual report to its shareholders shall file a copy of said report with the Division of Medical Assistance.  Said report shall be filed within 30 days of its issuance to the shareholders.

(4)           Each provider that has a compensatory stock option plan shall file a copy of said plan with the Division of Medical Assistance, within 30 days of its implementation.

(5)           A provider shall file an information report with the Division of Medical Assistance within 30 days of receiving notification from either the North Carolina Department of Revenue or the Internal Revenue Service that items, previously reported and allowed on a cost report, have been disallowed on the provider's associated tax return.

(c)  Requirements for certification of financial reports.

(1)           Each provider that operates a facility shall complete the required financial reports in accordance with the following rules and in the order of priority stated:

(A)          Cost shall be represented in accordance with the specific provisions of the plan as set forth in this Rule.

(B)          Costs shall be reported in conformance with the Medicare Provider Reimbursement Manual, HCFA 15, which is hereby incorporated by reference including subsequent amendments and editions.  Said manual is commonly referred to as the HIM‑15 manual and is available for inspection at the Division of Medical Assistance, 1985 Umstead Drive, Raleigh, North Carolina 27603.  Copies may be obtained from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402‑9325 at a cost of three hundred fifty seven dollars ($357.00).  Tel: (202) 783‑3238.

(C)          Costs shall be reported in conformance with generally accepted accounting principles.

(D)          Governmental institutions have the option of using the accrual or cash method of accounting.

(2)           Cost reports prepared for facilities shall be certified for their compliance with Subparagraph (c)(1) of this Rule by the provider's executive director or designated officer.

(3)           Budget reports prepared for facilities shall be certified for their fair representation of anticipated disbursements and receipts related to the Medicaid ICF‑MR program by the provider's executive director or designated officer.

(d)  Requirements for the revision of financial reports shall include the following:

(1)           In the event the Division of Medical Assistance determines a cost report does not meet the requirement of the Division of Medical Assistance during a detailed review, the provider shall have 30 days from the date of said notification to submit a revised cost report or additional data.  Such revised data or report shall be certified by the provider's executive director or designated officer.

(2)           In the event that the provider discovers that a report submitted to the Division of Medical Assistance is incomplete, inaccurate or incorrect the provider shall immediately notify the Division of Medical Assistance that such error(s) exist.  The provider shall have 30 days from the date of said notification to submit a revised report or additional data.  Such data or report shall meet the certification requirements of the report being corrected.

(3)           Failure to file the corrected reports on a timely basis in accordance to either Subparagraph (d)(1) or (2) of this Rule shall result in the related report being considered not filed and subject to the provisions under this Rule related to the failure to file said reports.  However, the Division of Medical Assistance may grant an extension of time of up to 30 days to file said corrected reports, upon the showing of just cause by the provider in writing.

 

History Note:        Filed as a Temporary Amendment Eff. July 8, 1993, for a period of 180 days or until the permanent rule becomes effective, whichever is sooner.

Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; 42 C.F.R. 447, Subpart C;

Eff. January 1, 1982;

Amended Eff. August 1, 1995; November 1, 1993; May 1, 1990; April 1, 1988.