10A NCAC 22G .0309. AUDITS

(a)  Each facility shall maintain the statistical and financial records which formed the basis of the reports required by this Rule and submitted to the Division of Medical Assistance for five years from the date on which the reports were submitted or due, whichever is later, or for such longer periods as may be required under State or Federal law.  Each cost report shall be verified by the state agency or its representative for completeness, accuracy, and reasonableness through a desk audit.  Field audits shall be performed as required.  When a combined cost report is filed under this plan, only the combined cost report is subject to desk and field audit, unless the Division of Medical Assistance determines that the supporting individual facility cost reports need to be audited.

(b)  All such records shall be subject to audit for a period of five years from the later of the date on which all required reports were filed with the Division of Medical Assistance or the date on which such reports were due.

(1)           Desk or field audits shall be conducted by the Division of Medical Assistance, its designated contract auditors, or other governmental agencies at a time and place and in a manner determined by said governmental agencies.

(2)           The audits may be performed on any financial or statistical records required to be maintained.

(3)           Any findings of a described audit of this Rule shall constitute grounds for recoupment at the discretion of the Division of Medical Assistance, provided that such audit finding relates to the allowable costs.

(c)  All filed cost reports shall be desk audited and tentative settlements made in accordance with the provisions of this plan.  This settlement shall be issued within 180 days of the date the cost report was filed or within 272 days of the end of the June 30 fiscal year reflected in the cost report, whichever is later.  The state may elect to perform field audits on any filed cost reports within three years of the date of filing and issue a final settlement on a time schedule that conforms to Federal law and regulation.  If the state decides not to field audit a facility a final reimbursement notice may be issued based on the desk audited settlement.  The state may reopen and field audit any cost report after the final settlement notice in order to comply with Federal law and regulation or to enforce laws and regulations prohibiting abuse of the Medicaid Program and particularly the provisions of this reimbursement plan.

(d)  These changes to the Payment for Services Prospective Reimbursement Plan for ICF‑MR Facilities will become effective when the Health Care Financing Administration, U.S. Department of Health and Human Services, approves amendment submitted to HCFA by the Director of the Division of Medical Assistance on or about July 1, 1995 as #MA 95‑03, wherein the Director proposes amendments of the State Plan to amend Payment for Services ‑ Prospective Reimbursement Plan for ICF‑MR Facilities.

 

History Note:        Filed as a Temporary Adoption 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. November 1, 1993;

Amended Eff. August 1, 1995.