Tenn. Comp. R. & Regs. 1200-13-08-.08 - SUBMISSION OF COST REPORTS BY PROVIDERS

(1) In-state and out-of-state Providers of Medicaid Level II nursing care will be required to contract with the Department and submit to the Comptroller of the Treasury a pro-forma (budgeted) cost report upon beginning participation as a new provider. Leases and changes of ownership are not considered new providers for this purpose and thus no budgeted cost reports are filed for leases or changes in ownership. Thereafter, cost reports shall be filed at their fiscal year end on forms designated by the Department. The report shall be due within three (3) months after the end of the designated fiscal period or the alternative due date designated by Medicare if applicable. An extension may be requested for due cause. Such cost reports must be completed in accordance with Medicare reimbursement principles except where these rules may specify otherwise. All covered charges are to be in accordance with the Medicaid Program definition of covered services. Also, all charges to Medicaid recipients must be made consistently and in accordance with the providers schedule of charges in effect for the period covered for all patients. In the event that a provider does not file the required cost report by the due date, the provider shall be subject to a penalty of ten dollars ($10.00) per day in accordance with T.C.A. 12-4-304. In the event that a provider discovers a significant omission of costs, it may file an amended cost report at any time prior to the due date of its next annual cost report. After that time, the cost report cannot be amended for cost omissions. Amended cost reports shall be subject to the same requirements as other cost reports, and will be the only accepted means to claim omitted costs. Rate increases resulting from submission of omitted costs will not be retroactive.
(2) Providers of skilled nursing care that do not file cost reports required in this section or do not file the cost reports in a timely manner as provided in Medicare Principles of Reimbursement, in effect October 1, 1984, may be subject to sanctions as provided by the Medicare Principles of Reimbursement. Providers of skilled nursing care who fail to file cost reports for a specific period shall be subject to penalties in accordance with state law.
(3) After a period of five years following the implementation of Medicaid prospective payment for Level II nursing facility services on October 1, 1996, amended or corrected Level II nursing facility cost reports with claims for reimbursement for services prior to October 1, 1996 shall not be accepted.


Tenn. Comp. R. & Regs. 1200-13-08-.08
Original rule filed March 7, 1989; effective April 21, 1989. Amendment filed October 14, 1998; effective December 28, 1998. Amendment filed July 25, 2002; effective October 8, 2002.

Authority: T.C.A. ยงยง 4-5-202, 12-4-301, 71-5-105, 71-5-109, and Executive Order No. 23.

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