Cal. Code Regs. Tit. 22, § 52516 - Audits and Audit Adjustments

(a) The Department shall conduct full-scope field audits of all FS/NF-B facilities and home offices participating in the Medi-Cal program a minimum of once every three years. Limited scope reviews shall be conducted at intervening periods. All FSSA/NF-Bs shall be subject to audit on an annual basis.

(b) Audited cost data shall be used to develop facility-specific reimbursement rates.

(c) Overpayments to any facility shall be recovered pursuant to Welfare and Institutions Code, Section 14126.023 and Title 22, California Code of Regulations, Section 51047.

(d) Facilities have the right to appeal audit or examination findings. Specific appeal procedures are contained in Welfare and Institutions Code Section 14171, and Title 22, California Code of Regulations, Sections 51016 through 51048.

(e) For facilities that obtain an audit appeal decision that results in revision of the facility's allowable costs used to calculate a facility's reimbursement rate, the Department shall make a retroactive adjustment in the facility-specific reimbursement rate.

Notes

Cal. Code Regs. Tit. 22, § 52516

1. New section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register 2010, No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or emergency language will be repealed by operation of law on the following day. Any rules issued by provider bulletin by the Department of Health Care Services that are covered by or inconsistent with these emergency regulations are superseded as of the effective date of these emergency regulations.
2. New section refiled 1-10-2011 as an emergency, including amendment of subsection (b); operative 1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be transmitted to OAL by 4-18-2011 or emergency language will be repealed by operation of law on the following day. Any rules issued by provider bulletin by the Department of Health Care Services that are covered by or inconsistent with these emergency regulations are superseded as of the effective date of these emergency regulations.
3. Certificate of Compliance as to 1-10-2011 order, including amendment of subsections (a) and (d), transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No. 20).

Note: Authority cited: Sections 20, 1324.20, 1324.21 and 1324.23, Health and Safety Code; and Sections 10725, 14105, 14124.5, 14126.027, 14170 and 14171, Welfare and Institutions Code. Reference: Sections 14105, 14109.5, 14110.1, 14110.6, 14170 and 14171, Welfare and Institutions Code.

1. New section filed 7-22-2010 as an emergency; operative 7-22-2010 (Register 2010, No. 30). A Certificate of Compliance must be transmitted to OAL by 1-18-2011 or emergency language will be repealed by operation of law on the following day. Any rules issued by provider bulletin by the Department of Health Care Services that are covered by or inconsistent with these emergency regulations are superseded as of the effective date of these emergency regulations.
2. New section refiled 1-10-2011 as an emergency, including amendment of subsection (b); operative 1-18-2011 (Register 2011, No. 2). A Certificate of Compliance must be transmitted to OAL by 4-18-2011 or emergency language will be repealed by operation of law on the following day. Any rules issued by provider bulletin by the Department of Health Care Services that are covered by or inconsistent with these emergency regulations are superseded as of the effective date of these emergency regulations.
3. Certificate of Compliance as to 1-10-2011 order, including amendment of subsections (a) and (d), transmitted to OAL 4-5-2011 and filed 5-17-2011 (Register 2011, No. 20).