Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-56 - FEDERALLY QUALIFIED HEALTH CENTER REIMBURSEMENT › Section 560-X-56-.15 - Cost Reports

Current through Register Vol. 42, No. 9, June 28, 2024
(1) General -
			 New FQHCs must file a cost report, using Medicaid's prescribed cost report
			 forms, when (1) submitting an operating budget to establish a budget rate and
(2) submitting actual cost to
			 settle the budget period. The due date to submit the cost report to settle the
			 budget period will be given in correspondence to the provider by Medicaid. Each
			 new FQHC 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 or Medicaid number, five cost reports should be filed
			 using five different NPI numbers. An extension of the due date given by
			 Medicaid may be granted 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
(2)
			 Penalties. If a complete cost report is not filed by the due date given in
			 correspondence to the provider by Medicaid, 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.
(3) Each cost report will
			 be signed by the administrator or by an officer of the FQHC. 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 FQHC in accordance with applicable instructions, except as noted.
________________________________________
Signature (Officer or Administrator) Title Date
(4) 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.
(5) Cost reports
			 should be prepared with due diligence and care to prevent the necessity for
			 later submittals of corrected or supplemental information by providers. 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.
(6) 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-day 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.
Author:
Sandra Johnson, Associate Director,
				  Provider Audit, Q/A Reimbursement
Statutory Authority:
State Plan; Title XIX,
				  Social Security Act, 42
				  C.F.R.§
											405.2401- 2429.