Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-62 - REGIONAL CARE ORGANIZATIONS › Section 560-X-62-.17 - Financial Reporting And Audit Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Each regional care organization ("RCO")
			 shall provide to the Medicaid Agency a periodic financial report setting forth
			 information concerning the RCO's restricted reserves, 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, each RCO 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 RCOs use specific reporting forms in order to supply required
			 information.
(2) Each RCO 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 RCO which could result in a
			 determination of hazardous financial condition or insolvency pursuant to
			 Alabama Administrative Code Rule
			 560-X-62-.18, including but not
			 limited to any deficiency in the required restricted reserves or capital and
			 surplus of the RCO, the RCO 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 RCO.
(4) Each RCO
			 shall at its expense have its independent certified public accountant deliver
			 directly to the Medicaid Agency the certified audited annual financial
			 statements of the RCO, prepared in accordance with generally accepted
			 accounting principles (GAAP), no later than 120 days after the RCO's fiscal
			 year end, for the immediately preceding fiscal year. The Medicaid Agency may
			 require that supplemental financial information be included in the RCO's
			 audited financial statements related to restricted reserves, capital and
			 surplus, and other related information. A statement shall be included with the
			 audit report delivered by the RCO's accountant acknowledging that the Medicaid
			 Agency is an intended beneficiary of the audit report.
(5) In addition to the annual audits
			 conducted by the RCO's independent certified public accountant, the Medicaid
			 Agency shall conduct or contract for audits of each RCO, in accordance with
			 Section 22-6-153(h)(5) of
			 the Alabama Code, as often as the Medicaid Agency deems necessary or
			 appropriate, but at least every three years.
(a) The audits shall be conducted for the
			 purposes of determining the financial condition of the RCO, its means and
			 ability to fulfill its obligations, the nature of its operations, and/or its
			 compliance with applicable provisions of the risk contract, rules of the
			 Medicaid Agency, and other applicable state and federal laws and
			 regulations.
(b) When the Medicaid
			 Agency determines that an audit should be conducted, the Medicaid Agency shall
			 appoint one or more auditors to perform the audit and instruct them as to the
			 scope of the audit. The Medicaid Agency may adopt or prescribe such audit
			 guidelines and procedures as the Medicaid Agency from time-to-time determines
			 to be appropriate.
(c) The Medicaid
			 Agency may retain appraisers, independent actuaries, independent certified
			 public accountants or other professionals and specialists as needed to conduct
			 an audit. The reasonable cost of retaining such professionals and specialists,
			 and all other reasonable costs of the audit as determined by the Medicaid
			 Agency including transportation and travel expenses, shall be borne by the RCO
			 that is the subject of the audit.
(d) The RCO shall produce or provide timely,
			 convenient, and free access at all reasonable business hours at the offices of
			 the RCO to all books, records, accounts, papers, documents and electronic and
			 other recordings (hereafter collectively referred to in this rule as "books and
			 records") in its possession or control relating to the matter under audit,
			 including as applicable the property, assets, business and affairs of the RCO.
			 The officers, directors, and agents of the RCO shall facilitate the
			 audit.
(e) An audit report shall be
			 issued with respect to each audit of an RCO, as follows:
1. Not later than 60 calendar days after
			 completion of an audit, the auditor in charge of the audit shall submit to the
			 Medicaid Agency a written report of the audit, verified by the oath of the
			 auditor. The audit report shall comprise only information appearing upon the
			 books and records of the RCO, its agents, affiliates, or other persons being
			 examined or information from testimony of individuals concerning the affairs of
			 the RCO, together with such conclusions and recommendations as reasonably may
			 be warranted from such information.
2. The Medicaid Agency shall make a copy of
			 the audit report submitted under this section available to the RCO that is the
			 subject of the audit and shall give the RCO an opportunity to review and
			 respond to the audit report. The Medicaid Agency may request additional
			 information or meet with the RCO for the purpose of resolving questions or
			 obtaining additional information, and may direct the auditor to consider the
			 additional information for inclusion in the audit report. The Medicaid Agency
			 may issue the report as a final audit report after the RCO has had an
			 opportunity to review and respond to the report.
3. If the final audit report reveals that the
			 RCO has violated or is operating in violation of any provision of the risk
			 contract, rule of the Medicaid Agency, or any other applicable state or federal
			 law or regulation, the Medicaid Agency may order the RCO to take any action the
			 Medicaid Agency considers necessary and appropriate to cure such violation and
			 to take such additional actions and measures as may be permitted under the
			 rules of the Medicaid Agency or any other applicable law or
			 regulation.
4. A report filed as a
			 final audit report is subject to public inspection.
(f) Nothing in this rule shall be interpreted
			 to require the Medicaid Agency to conduct an audit, issue an audit report, or
			 wait any period of time before taking any action or exercising any authority,
			 right, or remedy available to the Medicaid Agency under the rules of the
			 Medicaid Agency, the risk contract, or applicable law.