Md. Code Regs. 10.09.93.11 - Cost Settlement - State-operated Chronic Hospitals
A. Final settlement for services in the
provider's fiscal year shall be determined based on Medicare retrospective cost
principles found at 42 CFR ยง 413, adjusted for Program allowable costs.
Allowable costs specific to the Program shall be limited to a base year cost
per discharge increased by the applicable federal rate of increase times the
number of Program discharges for that fiscal year.
B. Base Year. For purposes of determining
limits on the increase of cost, in accordance with Medicare regulations, the
base year for an existing provider shall be the first year of entering into the
Program or the first year separate rates for the unit or units of service or
services are approved.
C. The
provider shall supply the Department or its designee the assurances necessary
to establish that its customary charges to participants liable for payment
exceed the allowable cost for these services.
D. Revision of Interim Rates. The provider
may request an interim rate revision should the actual and projected cost
exceed the interim rate by 10 percent. The provider shall furnish the
Department or its designee with appropriate schedules showing the reason for
the increase and any other information supporting the request. The Department
will lower the provider's interim rate to closely approximate the final
allowable reasonable cost based on the results of the prior year's review. The
provider may request not more than two interim rate revisions during the
accounting year.
E. Cost
Settlement. The provider shall submit to the Department or its designee a
Medicaid cost report based on actual data using the cost reporting forms used
by Medicare for retrospective cost reimbursement. The provider shall also
submit a copy of its Maryland Medical Assistance log. The submitted cost report
shall be in sufficient detail to support a separate cost finding for designated
Maryland Medical Assistance unique cost centers. Tentative cost settlements may
not be performed on a routine basis. However, the Program reserves the right to
calculate tentative settlements in limited cases, when appropriate, as
determined by the Department. The provider shall furnish the Department or its
designee with a finalized Medicare cost report for the cost reporting year. The
Department will base final settlement on the results of the finalized Medicare
cost reports.
Notes
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