Or. Admin. R. 410-125-1020 - Filing of Cost Statement
Current through Register Vol. 60, No. 12, December 1, 2021
(1)
The hospital must file an annual Calculation of Reasonable Cost (DMAP 42),
covering the latest fiscal period of operation of the hospital with Division of
Medical Assistance Programs (Division):
(a) A
Calculation of Reasonable Cost statement is filed for less than an annual
period only when necessitated by the hospital's termination of their agreement
with the Division, a change in ownership, or a change in the hospital's fiscal
period;
(b) The hospital must use
the same fiscal period for the Division 42 as that used for its Medicare
report. If it doesn't have an agreement with Medicare, the hospital must use
the same fiscal period it uses for filing its federal tax return;
(c) The report must be filed for both
inpatient and outpatient services, even if the service is paid under a
prospective payment system or fee schedule (e.g., Diagnosis-Related Groups
(DRG) payments, outpatient clinical laboratory, etc.);
(d) In the absence of an agreement with
Medicare, the hospital must use the same fiscal period as that used for filing
their Federal tax return.
(2) Twelve months after the hospital's fiscal
year end, the Division will send the hospital a computer printout listing all
transactions between the hospital and the Division during that auditing period.
The Calculation of Reasonable Cost statement (DMAP 42) is due within 90 days of
receipt by the hospital of the computer printout. Failure to file within 90
days may result in a 20 percent reduction in the payment rate:
(a) Hospitals without an agreement with
Medicare may be subject to a field audit;
(b) Hospitals without an agreement with
Medicare are required to submit a financial statement giving details of all
assets, liabilities, income, and expenses, audited by a Certified Public
Accountant.
(3)
Improperly completed or incomplete Calculation of Reasonable Cost statements
will be returned to the hospital for proper completion. The statement is not
considered to be filed until it is received in a correct and complete
form.
(4) If a hospital knowingly,
or has reason to know, files a cost statement containing false information,
such action constitutes cause for termination of its agreement with the
Division. Hospitals filing false reports may also be referred to prosecution
under applicable statutes.
(5) Each
Calculation of Reasonable Cost statement submitted to the Division must be
signed by the individual who normally signs the hospital's Medicare reports,
federal income tax return, and other reports. If the hospital has someone,
other than an employee prepare the cost statement, that individual will also
sign the statement and indicate his or her status with the hospital.
(6) Notwithstanding subsection (1) of this
rule, this subsection becomes effective for dates of service on and after
January 1, 2006, but will not be operative as the basis for payments until the
Division determines all necessary federal approvals have been obtained. The
hospital must file with the Division, an annual Calculation of Reasonable Cost
(DMAP 42), covering the latest fiscal period of operation of the hospital:
(a) A Calculation of Reasonable Cost
statement is filed for less than an annual period only when necessitated by the
hospital's termination of their agreement with the Division, a change in
ownership, or a change in the hospital's fiscal period;
(b) The hospital must use the same fiscal
period for the DMAP 42 as that used for its Medicare report. If it doesn't have
an agreement with Medicare, the hospital must use the same fiscal period it
uses for filing its federal tax return;
(c) The report must be filed for both
inpatient and outpatient services, even if the service is paid under a
prospective payment system or fee schedule (e.g., DRG payments, outpatient
clinical laboratory, etc.);
(d) In
the absence of an agreement with Medicare, the hospital must use the same
fiscal period as that used for filing their Federal tax return.
(7) Inpatient rehabilitation
facilities are exempt from filing an annual calculation of reasonable Cost
(DMAP 42) and not cost settled.
Notes
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
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