Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 7 - WYOMING NURSING HOME REIMBURSEMENT SYSTEM › Section 7-32 - Audits

Current through July 13, 2024
(a) Field audits. The Department or CMS may
				perform a field audit of a provider at any time to determine the accuracy and
				reasonableness of cost reports submitted by the provider and the validity of
				rate adjustments made pursuant to a desk review.
(b) Desk review. The Department or CMS may
				perform a desk review of a provider at any time to determine the accuracy and
				reasonableness of cost reports submitted by the provider.
(c) The Department or CMS may perform field
				audits or desk reviews through employees, agents, or through a third party.
				Audits shall be performed in accordance with Generally Accepted Auditing
				Standards (GAAS).
(d)
				Disallowances.
(i) Non-allowable costs. If a
				field audit or desk review discloses non-allowable costs or costs for services
				and supplies not included in the per diem rate, the Department shall adjust the
				per diem rate retroactively to the beginning of the rate period in question,
				recover any overpayments pursuant to Section
				33 of this Chapter, and adjust the per diem
				rate for the remainder of the rate period.
(A) Costs which are not reasonably related to
				services included in the Medicaid per diem rate, or which are against public
				policy, contractual allowances, courtesy discounts, charity allowances, and
				similar adjustments or allowances are adjustments to revenue and, therefore,
				are not included in allowable cost. Non-allowable costs also include, but are
				not limited to:
(I) Advertising expense
				(other than help wanted ads and telephone directory expense);
(II) Attorney fees and other costs associated
				with negotiations, administrative proceedings, or litigation involving the
				Department, except as specified in settlement;
(III) Bad debts;
(IV) Cost arising from joint use of resources
				(including central office and pooled cost) not reasonably related to patient
				care;
(V) Capital costs due solely
				to changes in ownership;
(VI) Costs
				incurred in transactions with organizations related to the provider by common
				ownership or control, to the extent that such costs exceed the limits
				established under
				42 C.F.R. §
													413.17;
(VII) Costs incurred as a result of
				enforcement actions taken by the Department pursuant to Chapter 5 of the
				Wyoming Medicaid Rules, Long Term Care Facility Remedies, Terminations, and CMS
				in response to nursing facility deficiencies, including costs of directed
				in-service training, suspended or denied per diem payments, reimbursement
				expenses, transfer costs, and costs relating to state monitoring and/or the
				appointment of a temporary manager;
(VIII) Costs not reasonably related to
				patient care;
(IX) The costs
				associated with ancillary and other services attributable to Medicare Part A or
				Medicare Part B, including direct and indirect costs;
(1.) Ninety (90) percent of the costs
				identified pursuant to this paragraph shall be non-allowable costs, and one
				hundred (100) percent of Medicare bed days shall be removed.
(2.) When determining the capital component
				for nursing facilities with occupancy below ninety (90) percent Medicare days
				will be computed to reflect Medicare occupancy.
(X) Costs related to the acquisition,
				establishment or operation of an in-house pharmacy, other than the reasonable
				costs of a pharmacy consultant;
(XI) Costs related to extraordinary clients
				that exceed the per diem rate;
(XII) Costs related to hospice
				services;
(XIII) Costs (such as
				legal fees, accounting and administration costs, travel costs, and the costs of
				feasibility studies) which are attributable to the negotiation or settlement of
				the sale or purchase of any capital asset by acquisition or merger for which
				any Medicaid payment has been previously made;
(XIV) Federal income and excess profit
				taxes;
(XV) Fees paid to directors
				and salaries, wages or fees paid to non-working officers, employees or
				consultants;
(XVI) Fund-raising
				expenses;
(XVII) Interest or
				penalties on federal or state taxes;
(XVIII) Judgments entered against a nursing
				facility or settlements entered into by a nursing facility arising out of
				actions or inactions of the nursing facility's agents or employees, including
				judgments entered against a nursing facility's agent or employee that a nursing
				facility pays, or settlements involving the nursing facility's agent or
				employee that the nursing facility pays;
(XIX) Life insurance premiums for officers
				and owners and related parties, except the amount relating to a bona fide
				nondiscriminatory employee benefits plan;
(XX) Meals and lodging provided to guests and
				employees. If the cost cannot be ascertained, the revenue from meals and
				lodging furnished to guests and employees shall be offset against the
				appropriate cost;
(XXI)
				Prescription drugs;
(XXII) Public
				relations expenses;
(XXIII)
				Resident personal purchases;
(XXIV)
				Return on equity;
(XXV)
				Self-employment taxes;
(XXVI)
				Stockholder relations or stock proxy expenses;
(XXVII) Taxes or assessments
(XXVIII) Telephone, television and radio
				which are located in patient accommodations and which are furnished solely for
				the personal comfort of patients;
(XXIX) Value of services (imputed or actual)
				rendered by non-paid workers or volunteers; and
(XXX) Vending machines and related
				supplies.