Ala. Admin. Code r. 560-X-64-.10

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-64-.10 - Financial Reporting And Audit Requirements

(1) An Integrated Care Network ("ICN") shall provide to the Medicaid Agency a periodic financial report setting forth information concerning the ICN's capital and surplus, and such other information as the Medicaid Agency may require, in such form and content and at such frequency as may be prescribed by the Medicaid Agency from time to time. In addition, an ICN shall provide such other financial reports and information as may be required by the Medicaid Agency pursuant to applicable state and federal laws and regulations. The Medicaid Agency may require that ICNs use specific reporting forms in order to supply required information.

(2) An ICN shall report all data as required by the Medicaid Agency, consistent with the federal Health Insurance Portability and Accountability Act (HIPAA) as in effect from time to time.

(3) After there is any change in the financial condition of an ICN which could result in a determination of hazardous financial condition or insolvency pursuant to Rule 560-X-64-.11, including but not limited to any deficiency in the required capital and surplus of the ICN, the ICN shall promptly give notice to the Medicaid Agency describing the circumstances of such change and its plan of action for responding to the change. Notwithstanding any such plan of action, the Medicaid Agency may at any time take any action or exercise any authority, right, or remedy available in accordance with the rules of the Medicaid Agency, the risk contract, or applicable law in connection with such change in the financial condition of the ICN.

(4) An ICN shall at its expense have its independent certified public accountant deliver directly to the Medicaid Agency the annual audited financial statements of the ICN, prepared in accordance with Generally Accepted Accounting Principles (GAAP) and Generally Accepted Auditing Standards (GAAS), no later than one hundred twenty (120) calendar days after the ICN's fiscal year end, for the immediately preceding fiscal year. The Medicaid Agency may require that supplemental financial information be included in the ICN's audited financial statements related to capital and surplus, and other related information. A statement shall be included with the audit report delivered by the ICN's accountant acknowledging that the Medicaid Agency is an intended beneficiary of the audit report.

(5) In addition any other powers of the Medicaid Agency relating to the audits of ICNs, the Medicaid Agency may at any time require an ICN to produce such books and records in the possession of the ICN or its affiliates or risk-bearing participants as are reasonably necessary to ascertain the financial condition of the ICN or to determine compliance with the rules of the Medicaid Agency and the contract between the ICN and the Medicaid Agency. If the ICN or its affiliates or risk-bearing participants fails to comply with any such request within the period of time prescribed the Medicaid Agency, the Medicaid Agency may audit the ICN and its affiliates or risk-bearing participants to obtain such books and records, in addition to imposing sanctions or other remedies under the rules of the Medicaid Agency and/or the contract between the ICN and the Medicaid Agency. The Medicaid Agency shall report the failure to comply to all of the ICN's participating providers. The ICN shall pay the costs incurred by the Medicaid Agency.

(6) In accordance with 42 C.F.R. § 438.66, the Medicaid Agency has the authority to monitor the ICN's operations, including, at a minimum, operations related to violations of the conditions for federal financial participation, as set forth in subpart J of 42 C.F.R. § 438.

(7) The Medicaid Agency, CMS, the Office of the Inspector General, the Comptroller General, and their designees may, at any time, inspect and audit any records or documents of the ICN or its subcontractors, and may, at any time, inspect the premises, physical facilities, and equipment where Medicaid-related activities or work is conducted. The right to audit exists for ten (10) years from the final date of the risk contract term, including any extensions, or from the date of completion of any audit, whichever is later.

(8) Except as otherwise determined by the Medicaid Agency or required by applicable law, all financial reports submitted to the Medicaid Agency pursuant to this rule shall be public records subject to disclosure.

Ala. Admin. Code r. 560-X-64-.10

Adopted by Alabama Administrative Monthly Volume XXXV, Issue No. 11, August 31, 2017, eff. 9/25/2017.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 10, July 31, 2018, eff. 8/26/2018.

Author: Stephanie Lindsay, Administrator, Administrative Procedures Office

Statutory Authority:Code of Ala. 1975, 22-6-220 et seq.; 42 C.F.R. Part 438.