New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-5 - Long-term Home Health Care Programs › Section 86-5.7 - Audits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All fiscal and
					 statistical records and reports shall be subject to audit. In this respect, any
					 rate of payment certified by the State Commissioner of Health based on the
					 initial submission of base-year data and reports will be construed to represent
					 a provisional rate until such audit is performed and completed, at which time
					 such rate or adjusted rate will be construed to represent the final rate. In
					 addition to verifying costs as reports, this audit will determine if the cost
					 per visit or hour presented by the provider have, in fact, been those used in
					 monthly chart billings.
(b)
					 Subsequent to the filing of required fiscal and statistical reports, field
					 audits shall be conducted of the records of LTHHCP in a time and manner to be
					 determined by the department.
(c)
					 The required fiscal and statistical reports shall be subject to audit for a
					 period of six years from the date of their filing with the department. This
					 limitation shall not apply to situations in which fraud may be
					 involved.
(d) Upon completion of
					 the audit, the LTHHCP shall be afforded a closing conference. The LTHHCP may
					 appear in person or by anyone authorized in writing to act on behalf of the
					 LTHHCP. The LTHHCP shall be afforded an opportunity at such conference to
					 produce additional documentation in support of any modifications requested in
					 the audit.
(e) The LTHHCP shall be
					 provided with the final audit report, the rate computation sheet and any
					 resulting revision of the rate of reimbursement, which shall be final unless,
					 within 30 days of receipt of the final audit report, the long-term home health
					 care program initiates a bureau review of such final audit report by notifying
					 the Division of Health Care Financing, by registered or certified mail,
					 detailing the specific items of the audit report with which the provider
					 disagrees and such other material as the provider wishes to submit in its
					 behalf, and forwarding all material documentation in support of the LTHHCP's
					 position.
(f) The LTHHCP shall be
					 notified in writing of the determination of the controverted items of the final
					 audit report, including a statement of the reasons for such adjustments and the
					 appropriate citation to applicable law, regulation or policy. The rate as
					 adjusted in accordance with the determination of the bureau review shall be
					 final, except that the LTHHCP may, within 30 days of receipt of the
					 determination of the bureau review, initiate a hearing to refute those items of
					 the audit report adverse to the interests of the LTHHCP presenting a factual
					 issue by serving on the commissioner, by certified or registered mail, a notice
					 containing a statement of the legal authority and jurisdiction under which the
					 hearing should be held, a reference to the particular sections of the statutes
					 and rules involved, and a statement of the controverted items of the audit
					 report and bureau determination, together with copies of any documentation
					 relied on by the LTHHCP in support of its position.
(1) Upon receipt of such notice, the
					 commissioner shall:
(i) designate a hearing
					 officer to hear and recommend;
(ii)
					 establish a time and place for such hearing; and
(iii) notify the LTHHCP of the time and place
					 of such hearing at least 15 days prior thereto. The issues and documentation
					 presented by the LTHHCP at such hearing shall be limited to the factual issues
					 and documentation presented at the bureau review.