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<regulation prefix="Regulation" num=".21" citation="COMAR 10.09.10.21" title_num="10" subtitle_num="09" chapter_num="10" heading="Cost Reporting.">
  <paragraph num="A.">
    <text>The provider shall include, for purposes of cost finding, direct and indirect costs applicable to recipient care.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The provider shall specifically identify, in the cost report, costs associated with related organizations.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The provider shall maintain adequate financial records and statistical data according to generally accepted accounting principles and procedures. This system of accounts will provide as a minimum:</text>
    <paragraph num="(1)">
      <text>Maintenance of a chronological cash receipts and disbursements journal in sufficient detail to show the exact nature of the receipts and disbursements;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Proper reference to supporting invoice, voucher, or other form of original evidence;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Maintenance of an appropriate time reporting system for all personnel and proper payroll authorizations and vouchers;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Provision for payment by check (when financial transactions involve numerous small expenditures, an imprest petty cash fund may be established, provided adequate supporting vouchers are maintained);</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Maintenance of records on all assets capitalized and depreciation on the assets;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Maintenance of appropriate records of patient days by level of care;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Maintenance of records on an accrual basis;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Maintenance of a daily midnight bed census by recipient name in a form prescribed by the Department (use of the prescribed form may be waived by the Department or its designee where a provider demonstrates the ability to maintain a superior system of census information); and</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Maintenance of other records as required by the Department.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The provider shall keep all records available for inspection or audit by the Department or its designee at any reasonable time during normal business hours. Upon request by the Department or its designee, documentation of costs shall be made available by the provider during the course of verification. The provider shall have 30 days from the date of the request to provide documentation for undocumented costs. Costs for which documentation is not provided within the 30 days shall be deemed not allowable. The Department may grant, in writing, an extension of time upon written demonstration by the provider of good cause. Records shall be retained for 6 years after the month the cost report to which the materials apply is filed with the Department or its designee.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Financial and Statistical Data Required.</text>
    <paragraph num="(1)">
      <text>The provider shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 3 months after the end of the provider's fiscal year unless the Department grants the provider an extension or the provider discontinues participation in the Program.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If reports are not received within 3 months and an extension has not been granted, the Department shall reduce the per diem rate by 3 percent for services provided during the calendar month after the month in which the report is due and any subsequent calendar month through the month during which the report has been submitted.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If a provider discontinues participation, financial and statistical data shall be submitted to the Department within 45 days after the effective date of termination.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A 1-month extension will be granted upon written request in advance by the provider. The Department may not grant an extension longer than 1 month unless the delay in filing the report has been caused by fire, flood, or act of God, and an extension is not allowed past March 31 after the calendar year during which the provider's fiscal year ended unless the report cannot be submitted by that date due to fire, flood, or act of God.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>When a report is not submitted by the last day of the sixth month after the end of the provider's fiscal year, the Department shall impose one or more sanctions as provided for in Regulation .33 of this chapter.</text>
  </paragraph>
  <paragraph num="G.">
    <text>For purposes of §§E and F of this regulation, reports are considered received when the submitted reports are completed according to instructions issued by the Department or its designee.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.</text>
  </paragraph>
  <paragraph num="I.">
    <text>The Department, at its option, may request an additional cost report from a provider when a:</text>
    <paragraph num="(1)">
      <text>Change in the location of a provider's operation occurs; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Significant change occurs that would affect the appraised value of a facility, such as an increase in the number of beds by more than 10 percent.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>If the Department exercises its option under the provisions of §I of this regulation, the period covered by the two reports in the specific provider’s fiscal year shall be divided as follows:</text>
    <paragraph num="(1)">
      <text>Beginning of fiscal year to date of change; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Date of change through the end of the fiscal year.</text>
    </paragraph>
  </paragraph>
  <paragraph num="K.">
    <text>Except as indicated in §L of this regulation, administrative and routine, other patient care, and capital costs incurred by the provider exclusively for providing ventilator care are not allowed in these cost centers, but are allowable nursing service costs.</text>
  </paragraph>
  <paragraph num="L.">
    <text>For any provider who provides ventilator care on 50 percent or more of its Maryland Medical Assistance days of care, all costs incurred by the provider exclusively for providing ventilator care are not allowable costs.</text>
  </paragraph>
  <paragraph num="M.">
    <text>A provider which renders a minimal number of Maryland Medical Assistance days of care may not be subject to cost reporting or field verification requirements for a specified fiscal period when the following criteria are met:</text>
    <paragraph num="(1)">
      <text>The provider bills the Maryland Medical Assistance Program for less than 1,000 Maryland Medical Assistance days of care during the provider's fiscal period; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider gives notice to the Program within 3 months after the end of the provider's fiscal period of the intent to not file a cost report for that period.</text>
    </paragraph>
  </paragraph>
  <paragraph num="N.">
    <text>The notice required in §M(2) of this regulation shall include:</text>
    <paragraph num="(1)">
      <text>An assurance that the provider billed the Medical Assistance Program for less than 1,000 days of care in the fiscal period; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A statement that the provider agrees to accept as final reimbursement the average rate paid to all other nursing facilities in the facility’s geographic region identified in Regulation .30A of this chapter, minus the quality assessment add-on for facilities that are exempt from Nursing Facility Quality Assessment identified in COMAR 10.01.20.</text>
    </paragraph>
  </paragraph>
  <paragraph num="O.">
    <text>A provider that does not incur costs for over-the-counter drugs on behalf of its private pay residents may adjust its report in order to ensure final reimbursement that more accurately reflects its costs for Medicaid days of care. The provider shall divide its costs by Medicaid and other government-paid days, multiply the quotient by its private pay days of care, and report the product as an adjustment to its over-the-counter drug costs.</text>
  </paragraph>
  <paragraph num="P.">
    <text>Out-of-State facilities are not subject to cost reporting requirements</text>
  </paragraph>
</regulation>