Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-57 - HOME AND COMMUNITY-BASED SERVICES FOR THE STATE OF ALABAMA INDEPENDENT LIVING (SAIL) WAIVER › Section 560-X-57-.07 - Financial Accountability Of Operating Agency

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The financial accountability of the
			 operating agency for funds expended on Home and Community-Based services must
			 be maintained and provide a clearly defined audit trail. The operating agency
			 as described in the waiver document 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 operating agency will pay the travel cost of
			 the auditors to the location of the records.
(2) The operating agency may have their
			 records audited 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 recipient's PCCP and services rendered by
			 a sampling procedure. The review will include appropriateness of care and
			 proper billing procedures.
(4) The
			 operating agency will provide documentation of actual costs of services and
			 administration. Such documentation will be entitled "Quarterly Cost Report" for
			 the SAIL 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 document will be submitted to the Alabama Medicaid
			 Agency before the 1st 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 July - September
Due before December 1
Failure to submit the actual cost documentation may 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 for 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 non-governmental agencies, generally accepted accounting principles will
			 apply. Governmental and non-governmental agencies will utilize the accrual
			 method of accounting unless otherwise authorized by the Alabama Medicaid
			 Agency.
(6) Cost, Allowable and
			 Unallowable.
(a) 45 C.F.R., 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 serve as a guide
			 for non-governmental agencies. For governmental agencies, all reported cost
			 will be adjusted to actual cost at the end of the waiver year.
(c) Contract payments for the delivery of
			 specific services are allowable expenses. Thus, contracts for case management,
			 personal care, respite care, environmental accessibility adaptations, assistive
			 technology, and medical supplies 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
			 45 C.F.R.
			 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
			 45 C.F.R.
			 95.707. For automated data processing
			 equipment, see
			 45
			 C.F.R. 95.641. When approval is required, the
			 request will be made to 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 non-governmental 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. Costs covered by
			 other programs, such as:
(i) Prescription
			 drugs,
(ii) Dental
			 expenses,
(iii) Ambulance
			 service,
(iv) Inhalation, group,
			 speech, occupational, and physical therapy.
(v) Non-emergency transportation
2. The cost of advisory councils
			 or consultants without Alabama Medicaid Agency's approval.
3. Legal fees as follows:
(i) Retainers,
(ii) Relating to fair hearings,
(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.