Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-36 - HOME - AND COMMUNITY-BASED SERVICES FOR THE ELDERLY AND DISABLED › Section 560-X-36-.07 - Financial Accountability Of Operating Agencies

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The financial accountability of providers
			 for funds expended on home- and community-based services must be maintained and
			 provide a clearly defined audit trail. Providers must retain records that fully
			 disclose the extent and cost of services provided to eligible recipients for a
			 five-year period. These records must be accessible to the Alabama Medicaid
			 Agency and appropriate state and federal officials. If these records are not
			 available within the state of Alabama, the provider will pay the travel cost of
			 the auditors.
(2) The state
			 agencies as specified in the approved waiver document as operating agencies of
			 home- and community-based services, will have their records audited at least
			 annually at the discretion of the Alabama Medicaid Agency. Payments that exceed
			 actual allowable cost will be recovered by Medicaid.
(3) The Alabama Medicaid Agency will review
			 at least annually the recipient's care plans and services rendered by a
			 sampling procedure. The review will include appropriateness of care and proper
			 billing procedures.
(4) The state
			 agencies as specified in the approved waiver document will provide
			 documentation of actual costs of services and administration. Such
			 documentation will be entitled "Quarterly Cost Report for the Elderly and
			 Disabled Waiver." The "Quarterly Cost Report" will include all actual costs
			 incurred by the operating agency for the previous quarter and include costs
			 incurred year-to-date. This documentation will be submitted to the Alabama
			 Medicaid Agency before the first day of the third month of the next quarter.
			 Quarters are defined as follows:
(a) 1st October - December
Due before March 1
(b) 2nd January - March
Due before June 1
(c) 3rd April - June
Due before September 1
(d) 4th June - September
Due before December 1
Failure to submit the actual cost documentation can result in
				the Alabama Medicaid Agency deferring payment until this documentation has been
				received and reviewed. Quarterly Cost Reports will be reviewed to determine
				necessity of a field audit.
(5) Auditing Standards - Office of Management
			 and Budget (OMB) Circular A-87, "Cost Principles for State and Local
			 Governments" will apply to governmental agencies participating in this program.
			 For nongovernmental agencies, generally accepted accounting principles will
			 apply. Governmental and nongovernmental agencies will utilize the accrual
			 method of accounting unless otherwise authorized by the Alabama Medicaid
			 Agency.
(6) Cost, Allowable and
			 Unallowable --
(a) 45 CFR, Part 95, specifies
			 dollar limits and accounting principles for the purchase of equipment.
			 Purchases above the twenty-five thousand dollar limit require the approval of
			 Medicaid.
(b) OMB Circular A-87
			 establishes cost principles for governmental agencies and will act as a guide
			 for non-governmental agencies. For governmental agencies, all reported cost
			 will be adjusted to actual cost at the end of the fiscal year.
(c) Contract payments for the delivery of the
			 specific services are allowable expenses. Thus, contracts for case management,
			 personal care, homemaker, respite care, adult day health, and home delivered
			 meals are recognized expenses. All other contracts will require Medicaid
			 approval to ensure that functions are not being duplicated. For example,
			 outreach is to be performed by the case manager, thus, it would not be
			 appropriate to approve other contracts for outreach, unless it can be clearly
			 shown that the function is required and cannot be provided within the
			 established organization.
(d)
			 Allowable costs are defined in OMB Circular A-87. However, the following
			 restrictions apply:
1. Advertising is
			 recognized only for recruitment of personnel, solicitation of bids for services
			 or goods, and disposal of scrap or surplus. The cost must be reasonable and
			 appropriate.
2. The cost of
			 buildings and equipment is recognized. For governmental agencies, buildings and
			 equipment exceeding twenty-five thousand dollars will be capitalized in
			 accordance with 4 5 CFR §95.705 and depreciated through a use allowance of
			 two percent of acquisition cost for building and six and two-thirds percent for
			 equipment. Equipment that has a remaining value at the completion of the
			 project will be accounted for in accordance with 4 5 CFR §95.707 . For
			 automated data processing equipment, see 4 5 CFR §95.641 . When approval
			 is required, the request will be made to the Medicaid Agency in
			 writing.
3. The acquisition of
			 transportation equipment will require prior approval from the Alabama Medicaid
			 Agency. When approval is required, the request will be made to Medicaid in
			 writing.
4. Transportation is an
			 allowable expense to be reimbursed as follows:
(i) For nongovernmental agencies, it will be
			 considered as part of the contract rate.
(ii) For government and private automobiles
			 utilized by state employees, reimbursement will be made at no more than the
			 current approved state rate.
(iii)
			 All other types of transportation cost will be supported by documents
			 authorizing the travel and validating the payment.
(e) Unallowable costs are
			 specified in OMB Circular A-87. In addition to these, the following are not
			 covered by this program:
1. Cost covered by
			 other programs, such as:
(i) Prescription
			 drugs,
(ii) Dental
			 expense,
(iii) Physical
			 therapy.
(iv) Ambulance
			 service,
(v) Inhalation, group,
			 speech, occupational, and physical therapy.
2. The cost of advisory councils or
			 consultants without the Alabama Medicaid agency's approval.
3. Legal fees as follows:
(i) Retainers,
(ii) Relating to fair hearing,
(iii) In connection with lawsuits, which
			 result in an adverse decision,
(iv)
			 Services that duplicate functions performed by Medicaid or the provider, such
			 as eligibility determination for the program,
(v) Other legal fees not relating to the
			 providing of services to the beneficiaries.
4. Dues and subscriptions not related to the
			 specific services.