7 AAC 140.700 - End-stage renal disease facility enrollment requirements
(a) To be eligible
for payment under 7 AAC 105 - 7 AAC 160 for outpatient end-stage renal disease
services, a provider must
(1) be enrolled as
an end-stage renal disease services facility in accordance with
7
AAC 105.210;
(2) meet the requirements of 42 C.F.R. Part
494 (conditions for coverage for end-stage renal disease facilities), adopted
by reference in
7
AAC 160.900; and
(3) be enrolled as a Medicare
provider.
(b) If a
provider operates end-stage renal disease facilities at more than one site,
each site must enroll separately and meet the requirements of this
section.
(c) On or before the last
day of the sixth month after the close of its fiscal year, each end-stage renal
disease facility that is enrolled in this state's Medicaid program shall submit
an annual report to the department. The annual year-end report is required even
if the clinic did not provide medical services to Medicaid recipients during
that fiscal year. The annual year-end report must include the following:
(1) the most recent uniform Medicare cost
report submitted by the facility to the facility's Medicare fiscal
intermediary, including
(A) any supporting
schedules submitted with, or in support of, the facility's Medicare cost report
that were transmitted to the Medicare fiscal intermediary;
(B) audited financial statements that include
financial information specific to the reporting facility for the time period
that matches the submitted Medicare cost report; the submission must also
include any audit adjustments made by the financial statement auditors;
(C) reconciliation of the audited
financial statements to Worksheet A of the submitted Medicare cost report;
(D) the facility's post-audit
working trial balance; and
(E)
reconciliation of the post-audit working trial balance to Worksheet A of the
Medicare cost report; and
(2) appropriate Medicaid Form E-1-reporting
forms, adopted by reference in
7
AAC 160.900.
(d) If an end-stage renal disease facility
receives an extension for timely filing a Medicare cost report from the
facility's Medicare fiscal intermediary, the facility must forward to the
department, not later than 30 days after the date on the letter, a copy of the
Medicare fiscal intermediary's letter that grants the extension. After receipt
of the letter, the department will grant a corresponding extension for the
facility's year-end report.
(e)
Each annual year-end report will be date-stamped upon receipt by the
department. The department will acknowledge the date of receipt in a notice to
the provider. Not later than 20 days after receipt of an annual year-end
report, the department will review the report to determine whether the
submission is complete. Once the review has been completed,
(1) the department will send a notice to the
facility that the annual year-end report is incomplete;
(2) the department will clearly identify in
the notice the deficiencies and the time not later than which the department
must receive the corrected or modified annual year-end report; the department
will give the facility at least seven days following receipt of the notice to
submit the corrected or modified annual year-end report to the department; and
(3) if a notice is not sent to the
provider within the 20-day period, the department will treat the annual
year-end report as complete.
(f) The department may conduct audits,
perform special analysis, and review the records of an end-stage renal disease
facility to verify compliance with Medicare and Medicaid regulations. A
facility shall provide to the department financial and all other information
regarding Medicaid claims for services provided by the facility to eligible
recipients and shall provide access to all facility locations and records as
requested by the department.
(g)
If a facility fails to submit the annual year-end report, or if the department
determines the report to be incomplete and not corrected or modified as
required under (e) of this section, the department will withhold two percent of
any payment due to the facility until the end of the fiscal quarter that the
report is submitted and determined complete. The department will begin
withholding two percent of the treatment payment on the 30th day following the
date the complete annual report is due.
(h) The department will provide notice under
this section by means of electronic mail. However, if there is no electronic
mail account associated with the provider's enrollment, the department will
provide notice by means of United States mail.
Notes
Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.070
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