Wis. Admin. Code Office of the Commissioner of Insurance § Ins 3.51 - Reports by individual practice associations
(1) DEFINITIONS.
For the purpose of this section only:
(a)
"Accountant" means an independent certified public accountant who is duly
registered to practice and in good standing under the laws of this state or a
state with similar licensing requirements.
(b) "Individual practice association" means
an individual practice association as defined under s.
600.03(23g),
Stats., which contracts with a health maintenance organization insurer or a
limited service health organization to provide health care services which are
principally physician services.
(c)
"Work papers" are the records kept by the accountant of the procedures
followed, the tests performed, the information obtained, and conclusions
reached pertinent to the examination of the financial statements of the
independent practice association. Work papers include, but are not limited to,
work programs, analysis, memorandum, letters of confirmation and
representation, management letters, abstracts of company documents and
schedules or commentaries prepared or obtained by the accountant in the course
of the examination of the financial statements of the independent practice
association and which support the accountant's opinion.
(2)FILING OF ANNUAL AUDITED FINANCIAL
REPORTS. Unless otherwise ordered by the commissioner, an individual practice
association shall file an annual audited financial report with the commissioner
within 180 days after the end of each individual practice association's fiscal
year. This section applies to individual practice associations for fiscal years
terminating on or after March 31, 1991. The annual audited financial report
shall report the assets, liabilities and net worth; the results of operations;
and the changes in net worth for the fiscal year then ended on the accrual
basis in conformity with generally accepted accounting practices. The annual
audited financial report shall not be presented on the cash basis or the income
tax basis or any other basis that does not fully account for all the
independent practice association's liabilities incurred as of the end of the
fiscal year. The annual audited financial report shall include all of the
following:
(a) Report of independent
certified public accountant.
(b)
Balance sheet.
(c) Statement of
gain or loss from operations.
(d)
Statement of changes in financial position.
(e) Statement of changes in net
worth.
(f) Notes to the financial
statements. These notes shall include those needed for fair presentation and
disclosure.
(g) Supplemental data
and information which the commissioner may from time to time require to be
disclosed.
(3)SCOPE OF
AUDIT AND REPORT OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT. Financial
statements filed under sub. (2) shall be audited by an independent certified
public accountant. The audit shall be conducted in accordance with generally
accepted auditing standards. The commissioner may from time to time require
that additional auditing procedures be observed by the accountant in the audit
of the financial statements of the independent practice association under this
rule.
(4)AVAILABILITY AND
MAINTENANCE OF CPA WORK PAPERS.
(a) An
independent practice association required to file an audited financial report
under this rule shall, if requested by the office, require the accountant to
make available to the office all the work papers prepared in the conduct of the
audit. The independent practice association shall require that the accountant
retain the audit work papers for a period of not less than 5 years after the
period reported.
(b) The office may
photocopy pertinent audit work papers. These copies are part of the office's
work papers. Audit work papers are confidential unless the commissioner
determines disclosure is necessary to carry out the functions of the
office.
(5)CONTRACTS. A
health maintenance organization insurer contracting with an independent
practice association shall include provisions in the contract which are
necessary to enable the individual practice association to comply with this
section including, but not limited to:
(a)
Provisions providing for timely access to records;
(b) Provisions providing for maintenance of
necessary records and systems and segregation of records, accounts and assets;
and
(c) Other provisions necessary
to ensure that the individual practice association operates as an entity
distinct from the insurer.
Notes
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