Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-60 - PROVIDER BASED RURAL HEALTH CLINIC REIMBURSEMENT › Section 560-X-60-.13 - Cost Reports

Current through Register Vol. 42, No. 9, June 28, 2024
(1) General -
			 Cost report filing, using Medicaid prescribed cost report forms, is mandatory
			 for new PBRHCs when (1) submitting an operating budget to establish a budget
			 rate and
(2) submitting actual
			 cost to settle the budgeted period. Each new PBRHC 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 number, five
			 cost reports should be filed using five different NPI numbers.
(2) Cost Report (New PBRHCs) - Each new PBRHC
			 is required to file a complete cost report after the budget period ends. The
			 PBRHC fiscal year-end must be the same as the affiliated provider; i.e.,
			 hospital, nursing facility, home health agency, etc. This is because you must
			 show the allocation of costs to the PBRHC through a step-down procedure. If an
			 affiliated provider has five clinics, costs must be step-down separately to the
			 five individual clinics. If a clinic is a part of a hospital, the hospital
			 cannot file an abbreviated hospital cost report. The hospital cost report must
			 contain all schedules and attachments. The PBRHC cost report is due 90 days
			 after the fiscal year end.
(3) Cost
			 Report Filing - Two copies of the cost report must be received by Medicaid by
			 the due date given in correspondence to the provider. Each copy will have an
			 original signature of the administrator or an officer of the PBRHC. 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 PBRHC in accordance with
			 applicable instructions, except as noted.
___________________________________
Signature (Officer or Administrator) Title Date
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.
(4) Extensions. Cost reports shall
			 be prepared with due diligence and care to prevent the necessity for later
			 submittals of corrected or supplemental information by the PBRHC. Extensions
			 may be granted only upon written approval by Medicaid 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.
(5) Penalties. If a complete cost report is
			 not filed by the due date, 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.
(6) 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.
(7) 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 days' 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:
Code of Alabama
				  1975
, State Plan; Title XIX, Social Security Act,
				  42 C.F.R. Sections
				  405.2460 - .2472 and 447.371.