55 Pa. Code § 6210.93 - Auditing requirements related to cost reports
(a) Except in cases of provider delay or
delay requested by State or Federal agencies investigating possible criminal or
civil fraud, the Department will conduct either a field audit or desk review of
each cost report within 1 year of the latter of its receipt in acceptable form,
as defined in §
6210.78 (relating to allowable
costs) or, if the facility participates in Medicare and has reported home
office costs to the Department on its cost report, the Department's receipt of
the facility's Medicare home office audit, to verify, to the extent possible,
that the facility has complied with:
(1) This
chapter.
(2) Chapter 1101 (relating
to general provisions).
(3) The
limits established in Chapter 6211 (relating to allowable cost reimbursement
for non-State operated intermediate care facilities for individuals with an
intellectual disability).
(4) The
Department's "Cost Apportionment Manual for State Mental Hospitals and
Intellectual Disability Centers" for State operated ICFs/ID.
(5) HIM-15.
(6) The Department's cost allocation plan for
State operated ICFs/ID.
(b) An onsite field audit will be performed
on a periodic basis at reporting facilities. Participating facilities will
receive a field audit or a desk audit each year. Full scope field audits will
be conducted in accordance with auditing requirements in Federal regulations
and generally accepted auditing standards.
(c) An auditor may validate the costs and
statistics of the annual report by an onsite visit to the facility. The
auditors will then certify to the Department the allowable cost for the
facility as a basis for calculating a per diem and an annual adjustment. Based
on the certification and total interim payments received by the facility, the
Department will compute adjustments due the facility or due the Department for
the fiscal year. The Department will notify the facility of the annual
adjustment due after the annual cost report is audited.
(d) Financial and statistical records to
support cost reports shall be available to State and Federal agents upon
request.
Notes
The provisions of this § 6210.93 amended under section 443.1(2) and (3) of the Human Services Code (62 P.S. § 443.1(2) and (3)).
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