Wis. Admin. Code Office of the Commissioner of Insurance § Ins 3.51 - Reports by individual practice associations

Current through November 29, 2021

(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

Wis. Admin. Code Office of the Commissioner of Insurance § Ins 3.51
Cr. Register, August, 1990, No. 416, eff. 9-1-90.

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