Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.10 - Financial Reporting And Audit Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
(1) An Integrated Care Network ("ICN") shall
			 provide to the Medicaid Agency a periodic financial report setting forth
			 information concerning the ICN's capital and surplus, and such other
			 information as the Medicaid Agency may require, in such form and content and at
			 such frequency as may be prescribed by the Medicaid Agency from time to time.
			 In addition, an ICN shall provide such other financial reports and information
			 as may be required by the Medicaid Agency pursuant to applicable state and
			 federal laws and regulations. The Medicaid Agency may require that ICNs use
			 specific reporting forms in order to supply required information.
(2) An ICN shall report all data as required
			 by the Medicaid Agency, consistent with the federal Health Insurance
			 Portability and Accountability Act (HIPAA) as in effect from time to
			 time.
(3) After there is any change
			 in the financial condition of an ICN which could result in a determination of
			 hazardous financial condition or insolvency pursuant to Rule
			 560-X-64-.11, including but not
			 limited to any deficiency in the required capital and surplus of the ICN, the
			 ICN shall promptly give notice to the Medicaid Agency describing the
			 circumstances of such change and its plan of action for responding to the
			 change. Notwithstanding any such plan of action, the Medicaid Agency may at any
			 time take any action or exercise any authority, right, or remedy available in
			 accordance with the rules of the Medicaid Agency, the risk contract, or
			 applicable law in connection with such change in the financial condition of the
			 ICN.
(4) An ICN shall at its expense
			 have its independent certified public accountant deliver directly to the
			 Medicaid Agency the annual audited financial statements of the ICN, prepared in
			 accordance with Generally Accepted Accounting Principles (GAAP) and Generally
			 Accepted Auditing Standards (GAAS), no later than one hundred twenty (120)
			 calendar days after the ICN's fiscal year end, for the immediately preceding
			 fiscal year. The Medicaid Agency may require that supplemental financial
			 information be included in the ICN's audited financial statements related to
			 capital and surplus, and other related information. A statement shall be
			 included with the audit report delivered by the ICN's accountant acknowledging
			 that the Medicaid Agency is an intended beneficiary of the audit
			 report.
(5) In addition any other
			 powers of the Medicaid Agency relating to the audits of ICNs, the Medicaid
			 Agency may at any time require an ICN to produce such books and records in the
			 possession of the ICN or its affiliates or risk-bearing participants as are
			 reasonably necessary to ascertain the financial condition of the ICN or to
			 determine compliance with the rules of the Medicaid Agency and the contract
			 between the ICN and the Medicaid Agency. If the ICN or its affiliates or
			 risk-bearing participants fails to comply with any such request within the
			 period of time prescribed the Medicaid Agency, the Medicaid Agency may audit
			 the ICN and its affiliates or risk-bearing participants to obtain such books
			 and records, in addition to imposing sanctions or other remedies under the
			 rules of the Medicaid Agency and/or the contract between the ICN and the
			 Medicaid Agency. The Medicaid Agency shall report the failure to comply to all
			 of the ICN's participating providers. The ICN shall pay the costs incurred by
			 the Medicaid Agency.
(6) In
			 accordance with
			 42 C.F.R. §
									438.66, the Medicaid Agency has the authority
			 to monitor the ICN's operations, including, at a minimum, operations related to
			 violations of the conditions for federal financial participation, as set forth
			 in subpart J of 42 C.F.R. § 438.
(7) The Medicaid Agency, CMS, the Office of
			 the Inspector General, the Comptroller General, and their designees may, at any
			 time, inspect and audit any records or documents of the ICN or its
			 subcontractors, and may, at any time, inspect the premises, physical
			 facilities, and equipment where Medicaid-related activities or work is
			 conducted. The right to audit exists for ten (10) years from the final date of
			 the risk contract term, including any extensions, or from the date of
			 completion of any audit, whichever is later.
(8) Except as otherwise determined by the
			 Medicaid Agency or required by applicable law, all financial reports submitted
			 to the Medicaid Agency pursuant to this rule shall be public records subject to
			 disclosure.
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, 22-6-220 et seq.; 42 C.F.R. Part
				  438.