Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 70 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES - INPATIENT HOSPITAL SERVICES › Part V - Inpatient Hospital Payment System › Article 3 - Other Provisions for Payment of Inpatient Hospital Services › Section 12VAC30-70-450 - Cost reporting requirements

Current through Register Vol. 40, No. 24, July 15, 2024
Except for noncost-reporting general acute care hospitals
						and freestanding psychiatric facilities licensed as hospitals, all hospitals
						shall submit cost reports. All cost reports shall be submitted on uniform
						reporting forms provided by the state agency and by Medicare. Such cost reports
						shall cover a 12-month period. Any exceptions must be approved by the state
						agency. The cost reports are due not later than 150 days after the provider's
						fiscal year end. All fiscal year end changes must be approved 90 days prior to
						the beginning of a new fiscal year. If a complete cost report is not received
						within 150 days after the end of the provider's fiscal year, the program shall
						take action in accordance with its policies to ensure that an overpayment is
						not being made. When cost reports are delinquent, the provider's interim rate
						shall be reduced to zero. The reductions shall start on the first day of the
						following month when the cost report is due. After the delinquent cost report
						is received, desk reviewed, and a new prospective rate established, the amounts
						withheld shall be computed and paid. If the provider fails to submit a complete
						cost report within 180 days after the fiscal year end, a penalty in the amount
						of 10% of the balance withheld shall be forfeited to the state agency. The cost
						report will be judged complete when the state agency has all of the
						following:
1. Completed cost reporting
					 form or forms provided by DMAS, with signed certification or
					 certifications.
2. The provider's
					 trial balance showing adjusting journal entries.
3. The provider's financial statements
					 including, but not limited to, a balance sheet, a statement of income and
					 expenses, a statement of retained earnings (or fund balance), a statement of
					 changes in financial position, and footnotes to the financial statements.
					 Multi-level facilities shall be governed by subdivision 5 of this
					 subsection.
4. Schedules which
					 reconcile financial statements and trial balance to expenses claimed in the
					 cost report.
5. Hospitals which are
					 part of a chain organization must also file:
a. Home office cost report;
b. Audited consolidated financial statements
					 of the chain organization including the auditor's report in which he expresses
					 his opinion or, if circumstances require, disclaims an opinion based on
					 generally accepted auditing standards, the management report, and footnotes to
					 the financial statements;
c. The
					 hospital's financial statements including, but not limited to, a balance sheet,
					 a statement of income and expenses, a statement of retained earnings (or fund
					 balance), and a statement of cash flows;
d. Schedule of restricted cash funds that
					 identify the purpose of each fund and the amount;
e. Schedule of investments by type (stock,
					 bond, etc.), amount, and current market value.