Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 150 - Prospective Payment System; Other Payment › 7 AAC 150.200 - Facility audits and desk reviews

Current through May 31, 2024
(a) In
				administering the Medicaid program, the department may perform facility audits,
				desk reviews, and field audits of various types and scope and take the results
				of those facility audits, desk reviews, and field audits into account in
				establishing a facility's payment rate. The department will perform facility
				audits, desk reviews, and field audits with respect to a facility's year-end
				report submitted under
				7 AAC 150.130(c). The scope and
				frequency of facility audits, field audits, and desk reviews are determined at
				the department's discretion. This section does not apply to the department's
				conduct of investigations or audits regarding patient abuse or neglect, fraud,
				or other program noncompliance. This section does not limit the department's
				authority under this chapter to review and adjust items directly included in a
				facility's payment rate based on a budget submitted under
				7 AAC 150.130(b).
(b) If the department performs a field audit
				or desk review, the process in this subsection applies. The department will
				commence its field audit or desk review with respect to a facility's year-end
				report after the facility has filed its year-end report under
				7 AAC 150.130(c) and the department has
				determined the report to be complete under
				7 AAC 150.140(e). The department will
				review the facility's year-end report and provide written notice in accordance
				with 7 AAC 150.140(a) -
				(d). The department will complete its field audit or desk review of a
				facility's year-end report and provide to the facility a completed field audit
				or desk review report. The department will provide to the facility, as
				attachments to the department's completed report, a revised Medicare cost
				report, and a revised Medicare cost report in electronic format if the facility
				provided a CMS-approved electronic filing of its Medicare cost report with its
				annual year-end report. The department will provide the department's completed
				report and all attachments to the facility promptly upon completion, in
				accordance with (1) or (2) of this subsection, or (f) of this section. The
				following provisions apply to year-end field audit and desk review reports:
(1) if a facility's year-end report required
				by 7 AAC 150.130(c)
				is filed with the department no more than 150 days after the close of the
				facility's fiscal year and is determined by the department to be complete, the
				department will provide to the facility a completed report and the department's
				proposed adjustments to the year-end report for purposes of setting rates under
				this chapter no later than 40 days before the beginning of the facility's
				applicable rate year;
(2) if the
				facility's year-end report required by
				7 AAC 150.130(c) is filed with the
				department more than 150 days after the close of the facility's fiscal year,
				the department may establish a temporary rate for the facility pending
				establishment of the facility's permanent rate;
(3) a facility may file with the department a
				response to the department's field audit or desk review report no more than 40
				days after the date the department issues the report; the department may make
				additional related adjustments if the facility makes objections to the
				department's adjustments; the department will provide to the facility a
				description of any additional adjustments;
(4) adjustments proposed during the course of
				a desk review or a field audit are not limited to adjustments the department
				has made in prior desk reviews or audits; the department may make adjustments
				to reflect reporting in accordance with AS 47.07 and 7 AAC 105 - 7 AAC
				160.