405 IAC 1-12-4 - Financial report to office; annual schedule; prescribed form; extensions; penalty for untimely filing
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 4.
(a) Each
provider shall submit an annual financial report to the office not later than
ninety (90) days after the close of the provider's reporting year. The annual
financial report shall coincide with the fiscal year used by the provider to
report federal income taxes for the operation unless the provider requests in
writing that a different reporting period be used. Such a request shall be
submitted within sixty (60) days after the initial enrollment of a provider.
This option may be exercised only one (1) time by a provider. If a reporting
period other than the tax year is established, audit trails between the periods
are required, including reconciliation statements between the provider's
records and the annual financial report.
(b) The provider's annual financial report
shall be submitted using forms prescribed by the office. All data elements and
required attachments shall be completed so as to provide full financial
disclosure and shall include the following as a minimum:
(1) Patient or resident census
data.
(2) Statistical
data.
(3) Ownership and related
party information.
(4) Statement of
all expenses and all income.
(5)
Detail of fixed assets and patient or resident related interest bearing
debt.
(6) Complete balance sheet
data.
(7) Schedule of Medicaid and
private pay charges in effect on the last day of the reporting period and on
the rate effective date as defined by this rule. Private pay charges shall be
the lowest usual and customary charge.
(8) Certification statement signed by the
provider that:
(A) the data are true,
accurate, related to patient or resident care; and
(B) expenses not related to patient or
resident care have been clearly identified.
(9) Certification statement signed by the
preparer, if different from the provider, that the data were compiled from all
information provided to the preparer by the provider, and as such are true and
accurate to the best of the preparer's knowledge.
(c) Extension of the ninety (90) day filing
period shall not be granted unless the provider substantiates to the office
circumstances that preclude a timely filing. Requests for extensions shall be
submitted to the office prior to the date due, with full and complete
explanation of the reasons an extension is necessary. The office shall review
timely requests for extension and notify the provider of approval or
disapproval within ten (10) days of receipt. If the request for extension is
disapproved, the report shall be due twenty (20) days from the date of receipt
of the disapproval from the office. Untimely requests for an extension will not
result in a change to the original due date, nor will it alleviate the provider
from the penalty provision in subsection (d).
(d) Failure to submit an annual financial
report within the time limit required shall result in the following actions:
(1) No rate review requests shall be accepted
or acted upon by the office until the delinquent report is received, and the
effective date of the Medicaid rate calculated utilizing the delinquent annual
financial report shall be the first day of the month after the delinquent
annual financial report is received by the office. All limitations in effect at
the time of the original effective date of the annual rate review shall
apply.
(2) When an annual financial
report is thirty (30) days past due and an extension has not been granted, the
rate then currently being paid to the provider shall be reduced by ten percent
(10%), effective on the first day of the month following the thirtieth day the
annual financial report is past due and shall so remain until the first day of
the month after the delinquent annual financial report is received by the
office. Reimbursement lost as a result of this penalty cannot be recovered by
the provider.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 4.
(a) Each provider shall submit an annual financial report to the office not later than ninety (90) days after the close of the provider's reporting year. The annual financial report shall coincide with the fiscal year used by the provider to report federal income taxes for the operation unless the provider requests in writing that a different reporting period be used. Such a request shall be submitted within sixty (60) days after the initial enrollment of a provider. This option may be exercised only one (1) time by a provider. If a reporting period other than the tax year is established, audit trails between the periods are required, including reconciliation statements between the provider's records and the annual financial report.
(b) The provider's annual financial report shall be submitted using forms prescribed by the office. All data elements and required attachments shall be completed so as to provide full financial disclosure and shall include the following as a minimum:
(1) Patient or resident census data.
(2) Statistical data.
(3) Ownership and related party information.
(4) Statement of all expenses and all income.
(5) Detail of fixed assets and patient or resident related interest bearing debt.
(6) Complete balance sheet data.
(7) Schedule of Medicaid and private pay charges in effect on the last day of the reporting period and on the rate effective date as defined by this rule. Private pay charges shall be the lowest usual and customary charge.
(8) Certification statement signed by the provider that:
(A) the data are true, accurate, related to patient or resident care; and
(B) expenses not related to patient or resident care have been clearly identified.
(9) Certification statement signed by the preparer, if different from the provider, that the data were compiled from all information provided to the preparer by the provider, and as such are true and accurate to the best of the preparer's knowledge.
(c) Extension of the ninety (90) day filing period shall not be granted unless the provider substantiates to the office circumstances that preclude a timely filing. Requests for extensions shall be submitted to the office prior to the date due, with full and complete explanation of the reasons an extension is necessary. The office shall review timely requests for extension and notify the provider of approval or disapproval within ten (10) days of receipt. If the request for extension is disapproved, the report shall be due twenty (20) days from the date of receipt of the disapproval from the office. Untimely requests for an extension will not result in a change to the original due date, nor will it alleviate the provider from the penalty provision in subsection (d).
(d) Failure to submit an annual financial report within the time limit required shall result in the following actions:
(1) No rate review requests shall be accepted or acted upon by the office until the delinquent report is received, and the effective date of the Medicaid rate calculated utilizing the delinquent annual financial report shall be the first day of the month after the delinquent annual financial report is received by the office. All limitations in effect at the time of the original effective date of the annual rate review shall apply.
(2) When an annual financial report is thirty (30) days past due and an extension has not been granted, the rate then currently being paid to the provider shall be reduced by ten percent (10%), effective on the first day of the month following the thirtieth day the annual financial report is past due and shall so remain until the first day of the month after the delinquent annual financial report is received by the office. Reimbursement lost as a result of this penalty cannot be recovered by the provider.