Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter III - Allowances for Services › Section 144-101-III-67 - Principles of Reimbursement for Nursing Facilities › Subsection 144-101-III-67-12 - RECORD KEEPING AND RETENTION OF RECORDS

Current through 2024-29, July 17, 2024
12.1 Each provider must maintain complete
					 documentation, including accurate financial and statistical records, to
					 substantiate the data reported on the cost report, and must, upon request, make
					 these records available to the Department, or the U.S. Department of Health and
					 Human Services, and the authorized representatives of either agency.
12.2 Complete documentation means clear
					 evidence of all of the financial transactions of the provider and affiliated
					 entities, including but not limited to census data, ledgers, books, invoices,
					 bank statements, canceled checks, payroll records, copies of governmental
					 filings, time records, time cards, purchase requisitions, purchase orders,
					 inventory records, basis of apportioning costs, matters of provider ownership
					 and organization, resident service charge schedule and amounts of income
					 received by service, or any other record which is necessary to provide the
					 Commissioner with the highest degree of confidence in the reliability of the
					 claim for reimbursement. For purposes of this definition, affiliated entities
					 shall extend to realty, management and other entities for which any
					 reimbursement is directly or indirectly claimed whether or not they fall within
					 the definition of related parties.
12.3 The provider shall maintain all such
					 records for at least three (3) years from the date of filing, or the date upon
					 which the fiscal and statistical records were to be filed, whichever is the
					 later. The Division of Audit shall keep all cost reports, supporting
					 documentation submitted by the provider, correspondence, work papers and other
					 analysis supporting audits for a period of three (3) years. In the event of
					 litigation or appeal involving rates established under these regulations, the
					 provider and Division of Audit shall retain all records that are in any way
					 related to such legal proceeding until the proceeding has terminated and any
					 applicable appeal period has lapsed.
12.4 When the Department of Health and Human
					 Services determines that a provider is not maintaining records as outlined
					 above for the determination of reasonable cost under the program, the
					 Department, upon determination of just cause, shall send a written notice to
					 the provider that in thirty (30) days the Department intends to reduce
					 payments, unless otherwise specified, to a ninety percent (90%) level of
					 reimbursement as set forth in Principle 37 of these Principles. The notice
					 shall contain an explanation of the deficiencies. Payments shall remain reduced
					 until the Department is assured that adequate records are maintained, at which
					 time reimbursement will be reinstated at the full rate from that time forward.
					 If, upon appeal, the provider documents that there was not just cause for the
					 reduction in payment, all withheld amounts will be restored to the
					 provider.