7 AAC 43.850. Enrollment and reporting

(a) The division will enroll as a Medicaid provider of rural health clinic services an entity that

(1) the division has certified under 42 C.F.R. 491.1 - 42 C.F.R. 491.11 as being in compliance with 42 C.F.R. 405.2400 - 42 C.F.R. 405.2417; for purposes of this paragraph, 42 C.F.R. 491.1 - 42 C.F.R. 491.11 and 42 C.F.R. 405.2400 - 42 C.F.R. 405.2417, revised as of October 1, 2001, are adopted by reference;

(2) is enrolled as a Medicare provider;

(3) is not enrolled as another type of Medicaid provider for primary care or ambulatory services provided by the rural health clinic;

(4) meets the enrollment requirements for each service that the rural health clinic provides by provider type as required under this chapter; and

(5) is enrolled separately under this chapter as a dental provider or a dispensing pharmacy provider, if the entity provides dental or dispensing pharmacy services.

(b) If a rural health clinic operates in more than one site in the state, each site must enroll separately and independently meet the requirements of this section.

(c) For each site where it operates, a rural health clinic shall maintain sufficient financial records and statistical data to allow the department to identify and verify the costs and charges associated with providing services at each site.

(d) On or before the last day of the fifth month after the close of its fiscal year, a rural health clinic shall file an annual year-end report, even if the clinic did not provide medical services to Medicaid-eligible recipients during that fiscal year. The annual year-end report must contain the items listed in the definition of "year-end report" in 7 AAC 43.709, except that

(1) Medicare home office cost statements are not required;

(2) the required reconciliation of the post-audit working trial balance must be to the Medicare cost report worksheets A, A-1, and A-2; and

(3) the report must also include a worksheet detailing the total number of rural health clinic visits for the clinic's fiscal year; the worksheet must include rural health clinic visits for dental and other ambulatory services.

(4) rural health clinics may provide reviewed financial statements meeting the requirements of 7 AAC 43.689(j) (3)(A) and (B) instead of audited financial statements.

(e) If no change in the scope of services occurred during the rural health clinic's fiscal year, and the rural health clinic does not intend to request a change, the rural health clinic shall submit to the department, on or before the last day of the fifth month after the close of that fiscal year, a written statement indicating that no change in the scope of services occurred or is being requested.

(f) If a change in the scope of services occurred during the rural health clinic's fiscal year, the rural health clinic shall submit to the department the additional reports listed in this subsection. The data contained in the reports will be used to evaluate the change in scope of service request made under 7 AAC 43.860(j) , to adjust the rural health clinic payment rates in accordance with that subsection, and to ensure, in accordance with 7 AAC 43.860(g) (4), that the prospective payment rate does not exceed upper payment limits. The reports must be submitted on or before the last day of the fifth month after the close of the rural health clinic fiscal year during which the change in the scope of services occurred, and on or before the last day of the fifth month after 12 continuous months of operation with the change. The reports must include the following:

(1) a worksheet detailing the total number by which rural health clinic visits increased or decreased for the clinic's fiscal year due to the change in the scope of services;

(2) a narrative report that

(A) identifies the date the change in the scope of services occurred; and

(B) describes the type of change in the scope of services;

(3) a spreadsheet that details the costs that are associated with the change in the scope of services and reported on the Medicare cost report; the spreadsheet must

(A) identify the working trial balance, account numbers, and cost centers; and

(B) list all expense amounts associated with the change in the scope of services.

(g) If the facility receives an extension for filing the Medicare cost report from the Medicare intermediary, the facility must forward a copy of the intermediary's letter that grants the extension to the facility to the department. The department will then grant an extension for the year-end report and the change-in-scope report to coincide with the due date given by the Medicare intermediary. Otherwise, for good cause shown to the department's satisfaction, the department will grant a 30-day extension of the due date for submitting the information required under (e) - (f) of this section. In order to receive an extension from the department, a rural health clinic must submit to the department an extension request in writing before the due date. For purposes of this subsection, "good cause"

(1) means circumstances beyond the control of the rural health clinic that cause the reporting due date to be missed by several days; and

(2) includes natural disasters, hazardous weather, illness of the individual making the request, or specific medical emergencies that preclude timely submission.

(h) The department will withhold 20 percent of the payment due a rural health clinic if the clinic fails to submit complete information as required in (d) - (f) of this section. The department will restore, without interest, a payment withheld under this subsection, if the rural health clinic submits complete information as required in (d) - (f) of this section.

(i) The department may conduct audits, perform special analyses, and review the records of a rural health clinic to verify compliance with Medicare and Medicaid laws, audit claims for reimbursement submitted or paid, and make adjustments based on audits to a rural health clinic's payment rate. A rural health clinic shall provide to the department financial and all other information regarding Medicaid claims for services provided to eligible recipients, shall provide Medicare cost reports upon request, and shall provide access to all facilities and records.

(j) A rural health clinic may terminate its agreement to participate in the rural health clinic program by submitting a written notice to the department and identifying a termination date not less than 30 days after submitting the notice of termination.

History: Eff. 8/18/79, Register 71; am 5/5/84, Register 90; am 6/27/84, Register 91; am 7/11/2002, Register 163; am 3/18/2006, Register 177

Authority: AS 47.05.010

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