N.J. Admin. Code § 8:85-4.2

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:85-4.2 - Audits

(a) For the exclusive purpose of calculating interest, under 30:4D-17(f), "completion of the field audit" for nursing facility providers shall be defined in the following manner:

1. For all such audits and audit recovery cases pending on February 7, 1983, it shall mean the date that field work is completed, or the date information requested from the provider during the course of that field work is received, whichever is later;

2. For all such audits and audit recovery cases pending on March 1, 1983, which are, have been or will be referred either to the Legal Action Committee, or to the Division of Criminal Justice or other agency for criminal investigation, it shall mean the date the Division of Medical Assistance and Health Services (DMAHS), Office of Program Integrity Administration (OPIA), receives authorization to take administrative action.

3. For all such audits initiated on or after February 7, 1983, it shall mean the date the exit conference is completed or the date information requested from the provider during the course of the exit conference is received, whichever is later.

(b) Notwithstanding any of the previous subsections, if after the screening of any nursing facility provider audit the Assistant Director, OPIA, determines with reasonable justification that an act or omission on the part of the provider requires additional field work, for the exclusive purpose of calculating interest under 30:4D-17, the field audit shall be considered completed when the additional field work is completed.

(c) Notwithstanding any of the previous subsections, if after the screening of any nursing facility provider audit the Assistant Director, OPIA, determines with reasonable justification that an act or omission on the part of the provider requires that additional information or documentation be obtained from the provider, then a completed field audit shall, for the exclusive purpose of calculating interest, be considered reopened and interest shall again accrue for the period beginning 20 days from the date that the request for such information or documentation is received by the provider and ending on the date that all of the requested information or documentation is received by the agency making the request.

(d) Notwithstanding any of the previous subsections, if all or part of any nursing facility provider audit initiated on or after the effective date of this subsection is referred to the Division of Criminal Justice or other agency for criminal investigation:

1. In the event no criminal action results from the referral the field audit shall be considered completed one year from the date the decision was made to refer the matter for criminal investigation;

2. In the event criminal action does result from the referral, the field audit shall be considered completed on the date OPIA receives authorization to take administrative action.

N.J. Admin. Code § 8:85-4.2

Amended by R.1983 d.5, effective 2/7/1983 (operative March 1, 1983).
See: 14 New Jersey Register 1031(a), 15 New Jersey Register 155(a).
Amended by R.1985 d.177, effective 4/15/1985.
See: 16 New Jersey Register 2413(a), 17 New Jersey Register 966(a).
(a)2 added; (a)2 recodified to (a)3.
Correction: (a)3 was inadvertently omitted from code. It has been added.
See: 18 New Jersey Register 1205(c).
Administrative change, recodified from N.J.A.C. 10:63-1.22.
See: 24 New Jersey Register 3728(b).
Amended by R.1995 d.174, effective 3/20/1995 (operative April 1, 1995).
See: 27 New Jersey Register 281(a), 27 New Jersey Register 1307(a).
Recodified from N.J.A.C. 10:63-4.2 and amended by R.2005 d.389, effective 1/17/2006.
See: 36 New Jersey Register 4700(a), 37 New Jersey Register 1185(a), 38 New Jersey Register 674(a).
In (a)2, added "Division of Medical Assistance and Health Services (DMAHS)".