Sec.17-312-105. Other related information

(a) Rebasing

After the implementation year, the Commissioner may in his sole discretion, select a new base period using actual cost data from more recent years for prospectively determining the target rate in the event that he determines that to do so is appropriate, equitable and does not prejudice the interests of the State.

(b) Allowable and Nonallowable Costs

Allowable costs, nonallowable costs, and reasonableness of costs will be based on Medicare principles of reimbursement as defined in Section 17-312-102.

(c) Reporting Year

For the purpose of determining payment rates, the reporting year is the hospital's fiscal year.

(d) Excludable costs

The Department will reimburse hospitals for hospital based physicians, capital, direct medical education, malpractice, and kidney acquisition costs attributable to Medicaid based on Medicare principles of reimbursement.

(e) Change of Ownership Resulting From a Sale or Lease

When a sale or lease occurs, the provider's target rate basis will remain the same as before the transaction.

(f) Retention of Records

Each hospital will maintain financial and statistical records of the period covered by such cost reports for a period of not less than ten years following the date of submittal of the cost report to the Department. These records must be accurate and in sufficient detail to substantiate the cost data reported. The provider will make such records or copies thereof available upon demand to the Department, or its representatives.

(g) Audits

(1) Desk Audit

Each cost report will be subjected to a review to ensure completeness, appropriateness and accuracy.

(2) Field Audit

Field audits will be performed on a timetable determined by the Department. The purpose of the field audit of the facility's financial and statistical records is to verify that the data submitted on the cost report is accurate, complete and reasonable. The field audits are conducted in conformity with Medicare regulations and are of sufficient scope to determine that only proper items of cost applicable to the services furnished were included in the provider's calculation of its costs and to determine whether the expense attributable to such proper items of cost were accurately determined to be reasonable. Any item not supported by adequate documentation or which is found to be unallowable will be disallowed by field audit. Proper adjustments to future payments will be made to recover amounts determined by field audit to be overpayments.

(h) Whenever a Medicare cost report is reopened, the result of the reopening will be applied to the Medicaid cost report.

(i) Notwithstanding any of the above provisions, any requirements mandated by changes in Federal law applicable to the Medicaid program shall be hereby incorporated into these regulations and shall supersede any contrary provision of these regulations.

(Effective January 19, 1988)