Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-218 - Proposed, preliminary, and final settlements

Current through Register Vol. 24-14, July 15, 2024
(1)  For each component rate, the department
				must calculate a proposed, preliminary, or final settlement at the lower of
				prospective payment rate or audited allowable costs, except as otherwise
				provided in this chapter or chapter 74.46 RCW.
(2)  As part of the cost report, the proposed
				settlement report is due in accordance with WAC
				388-96-022. In the proposed
				preliminary settlement report, a contractor must compare the contractor's
				payment rates during a cost report period, weighted by the number of resident
				days reported for the same cost report period to the contractor's allowable
				costs for the cost report period. In accordance with WAC
				388-96-205,
				388-96-208, and
				388-96-211 the contractor must
				take into account all authorized shifting, retained savings, and upper limits
				to rates on a cost center basis.
(3)
				 The department will review the proposed preliminary settlement
				report for accuracy and accept or reject the contractor's proposal. If
				accepted, the proposed preliminary settlement report must become the
				preliminary settlement report. If rejected, the department must issue, by
				component payment rate allocation, a preliminary settlement report fully
				substantiating disallowed costs, refunds, or underpayments due and adjustments
				to the proposed preliminary settlement.
(4)
				 When the department receives the proposed preliminary settlement
				report by the cost report due date specified in WAC
				388-96-022, it will issue the
				preliminary settlement report within one hundred twenty days of the cost report
				due date When the department receives the proposed preliminary settlement
				report after the cost report due date specified in WAC
				388-96-022, it will issue the
				preliminary settlement report within one hundred twenty days of the date the
				cost report was received. In its discretion, the department may designate a
				date later than the dates specified in this subsection to issue preliminary
				settlements.
(5)  A contractor has
				twenty-eight days after receipt of a preliminary settlement report to contest
				such report under WAC
				388-96-901 and
				388-96-904. Upon expiration of
				the twenty-eight day period, the department must not review or adjust a
				preliminary settlement report. Any administrative review of a preliminary
				settlement must be limited to either calculation of the settle-ment or
				application of settlement principles and rules, or both, and must not encompass
				rate or audit issues.
(6)  The
				department must issue a final settlement report to the contractor after the
				completion of the department audit process, including exhaustion or termination
				of any administrative review and appeal of audit findings or determinations
				requested by the contractor, but not including judicial review as may be
				available to and commenced by the contractor.
(7)  The department must prepare a final
				settlement by component payment rate allocation and must fully substantiate
				disallowed costs, refunds, underpayments, or adjustments to the cost report and
				financial statements, reports, and schedules submitted by the contractor. The
				department must take into account all authorized shifting, savings, and upper
				limits to rates on a component payment rate allocation basis. For the final
				settlement report, the department must compare the payment rates it paid the
				contractor for the facility in question during the report period, weighted by
				the number of allowable resident days reported for the period each rate was in
				effect to the contractor's:
(a)  Audited
				allowable costs for the reporting period; or
(b)
				 Reported costs for the nonaudited reporting period.