Section 7 AAC 140.200 - Health clinic enrollment and reporting(a) The department will pay a health clinic for services provided to a recipient if the health clinic (1) meets the enrollment and reporting requirements of 42 C.F.R. 405.2400-405.2444, adopted by reference in 7 AAC 160.900;(2) is a federally qualified health center that meets the requirements of 7 AAC 140.205 or a rural health clinic that meets the requirements of 7 AAC 140.210;(3) is enrolled as a Medicare provider;(4) is enrolled as a federally qualified health center or rural health clinic in accordance with 7 AAC 105.210;(5) is not enrolled as another type of Medicaid provider of primary care or ambulatory services provided by the health clinic;(6) employs staff who meet the individual provider enrollment requirements for each service that the clinic provides if enrollment is required for that type of provider under 7 AAC 105 - AAC 160; and(7) is enrolled as follows if the health clinic is providing those services: (A) as a dental provider under 7 AAC 110.140;(B) as a dispensing pharmacy provider under 7 AAC 120.100;(C) as a nurse midwife under 7 AAC 110.100 or direct-entry midwife under 7 AAC 110.180, if providing professional services associated with labor and delivery.(b) Each permanent site operated by a health clinic must be separately enrolled and meet the requirements of this section. In this subsection, "permanent site" (1) means a fixed, brick-and-mortar location; (2) does not include a temporary location where services are provided on a onetime or occasional basis, such as a health fair, school, or fish camp.(c) For each site where it operates, a 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 health clinic shall file an annual year-end report, even if the clinic did not provide medical services to 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 150.990, except that (1) worksheet A of the Medicare cost report must include separate cost centers for licensed marital and family therapists and for licensed professional counselors;(2) Medicare home office cost statements are not required;(3) the required reconciliation of the post-audit working trial balance must be to the Medicare cost report worksheets A, A-l, and A-2; reconciliation may not be made to the Medicare cost report worksheets A-8, C, and G series;(4) the report must also include a worksheet detailing the total number of visits for the clinic's fiscal year; the worksheet must include visits for dental, licensed marital and family therapist, licensed professional counselor, and other ambulatory services;(5) full-time-equivalent numbers must be reported separately for a licensed marital and family therapist or licensed professional counselor following the same calculation requirements as other rendering providers on Worksheet S-3 Part HI of the Medicare cost report; and(6) rural health clinics may provide reviewed financial statements meeting the requirements of 7 AAC 150.190(j)(3)(A) and (B) instead of audited financial statements.(e) If no change in the scope of services occurred during the health clinic fiscal year, and the health clinic does not intend to request a change, the health clinic shall submit to the department, on or before the last day of the fifth of the 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 scope of services occurred during the health clinic fiscal year, the health clinic shall submit to the department the additional reports listed in this subsection. The data contained in these reports will be used to evaluate the change in scope of service request made under 7 AAC 145.700(f), to adjust the health clinic payment rates in accordance with that subsection, and to ensure, in accordance with 7 AAC 145.700(c) (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 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 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 (d) - (f) of this section. In order to receive an extension from the department, a 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 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 to a 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 health clinic submits complete information as required in (d) - (f) of this section.(i) The department may conduct audits, perform special analysis, and review the records of a health clinic to verify compliance with Medicare and Medicaid laws, audit claims for payment submitted or paid, and make adjustments based on audits to a health clinic's payment rate. A 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 health clinic may terminate its agreement to participate as a rural health clinic or a federally qualified health center by submitting a written notice to the department and identifying a termination date not less than 30 days after submitting the notice of termination.(k) In this section, (a)(1) and (3) and (d) - (i) of this section do not apply to a federally qualified health center that elects to be reimbursed under 7 AAC 155.010(1).Eff. 2/1/2010, Register 193; am 11/1/2021, Register 240, January 2022; am 4/16/2023, Register 246, July 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.073
AS 47.07.074