California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 9 - Quality Assurance Fee and Long Term Care Reimbursement Methodology › Section 52516 - Audits and Audit Adjustments

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 The Department shall conduct full-scope field audits of all FS/NF-B facilities
					 and home offices participating in the Medi-Cal program a minimum of once every
					 three years. Limited scope reviews shall be conducted at intervening periods.
					 All FSSA/NF-Bs shall be subject to audit on an annual basis.
(b) Audited cost data shall be used to
					 develop facility-specific reimbursement rates.
(c) Overpayments to any facility shall be
					 recovered pursuant to Welfare and Institutions Code, Section
					 14126.023
					 and Title 22, California Code of Regulations, Section
					 51047.
(d) Facilities have the right to appeal audit
					 or examination findings. Specific appeal procedures are contained in Welfare
					 and Institutions Code Section
					 14171,
					 and Title 22, California Code of Regulations, Sections
					 51016 through
					 51048.
(e) For facilities that obtain an audit
					 appeal decision that results in revision of the facility's allowable costs used
					 to calculate a facility's reimbursement rate, the Department shall make a
					 retroactive adjustment in the facility-specific reimbursement rate.
1. New
						section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register
						2010,
						No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
2. New section refiled 1-10-2011 as an emergency,
						including amendment of subsection (b); operative 1-18-2011 (Register 2011, No.
						2). A Certificate of Compliance must be transmitted to OAL by 4-18-2011 or
						emergency language will be repealed by operation of law on the following day.
						Any rules issued by provider bulletin by the Department of Health Care Services
						that are covered by or inconsistent with these emergency regulations are
						superseded as of the effective date of these emergency
						regulations.
3. Certificate of Compliance as to 1-10-2011 order,
						including amendment of subsections (a) and (d), transmitted to OAL 4-5-2011 and
						filed 5-17-2011 (Register 2011, No. 20).
Note: Authority cited: Sections
						  20,
						  1324.20,
						  1324.21
						  and
						  1324.23,
						  Health and Safety Code; and Sections
						  10725,
						  14105,
						  14124.5,
						  14126.027,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14109.5,
						  14110.1,
						  14110.6,
						  14170
						  and
						  14171,
						  Welfare and Institutions Code.