Chapter 514 - Nursing Facility Services - DHHR - State of West ...

If it has been determined that a facility has significant deficiencies (defined as one or moredeficiencies cited at a severity level of actual harm or immediate jeopardy and/or constitutingsubstandard quality of care on the survey and licensure agency reports), the facility may bedenied efficiency incentive for that period. When an audit adjustment results in the allowablecosts in the Standard Services component, no increase or decrease in the efficiency incentivewill be made.514.13.44 Inflation FactorAfter combining the various components, a factor is assigned to costs as a projection of inflationduring the next rate-setting cycle. The amount of change in the Consumer Price Index (CPI)experienced during the six-month reporting period becomes the inflation factor applied to thenext six month period. The inflation factor, once set for a given rate period, is not adjusted as itrepresents what is a reasonable expectation for cost increases.Regulatory costs, such as minimum wage increases, tax changes, FICA increase, Worker’sCompensation changes, etc., will be considered an inclusive component of the inflation factor.514.13.45 AuditsDepartment staff will perform a desk review of cost reports prior to rate setting and will conducton-site audits of facility records periodically.514.13.46 Document/Desk ReviewFinancial and statistical reports submitted by the participating facilities will be subjected to adocument/desk review and analysis for rate setting within 60 days of receipt. Incomplete andinaccurate cost reports are not accepted.514.13.47 Field AuditPeriodic on-site audits of the financial and statistical records of participating facilities will beconducted to assure the validity of reported costs and statistical data. Facilities must maintainrecords to support all costs submitted on the Financial and Statistical Report and all data tosupport payroll and census reports. These records must be maintained at the facility or be madeavailable at the facility for review by Department staff (or their representatives) for auditpurposes upon notice. Records found to be incomplete or missing at the time of thescheduled on-site visit must be delivered to the Department within 48 hours or anamount of time agreed upon with audit staff at the exit conference. Costs found to beunsubstantiated will be disallowed and considered as an overpayment.514.13.48 Records RetentionAudit reports will be maintained by the Department for five years following date of completion.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 68January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.