Tenn. Comp. R. & Regs. 1200-13-08-.08 - SUBMISSION OF COST REPORTS BY PROVIDERS
(1) In-state
and out-of-state Providers of Medicaid Level II nursing care will be required
to contract with the Department and submit to the Comptroller of the Treasury a
pro-forma (budgeted) cost report upon beginning participation as a new
provider. Leases and changes of ownership are not considered new providers for
this purpose and thus no budgeted cost reports are filed for leases or changes
in ownership. Thereafter, cost reports shall be filed at their fiscal year end
on forms designated by the Department. The report shall be due within three (3)
months after the end of the designated fiscal period or the alternative due
date designated by Medicare if applicable. An extension may be requested for
due cause. Such cost reports must be completed in accordance with Medicare
reimbursement principles except where these rules may specify otherwise. All
covered charges are to be in accordance with the Medicaid Program definition of
covered services. Also, all charges to Medicaid recipients must be made
consistently and in accordance with the providers schedule of charges in effect
for the period covered for all patients. In the event that a provider does not
file the required cost report by the due date, the provider shall be subject to
a penalty of ten dollars ($10.00) per day in accordance with T.C.A. 12-4-304.
In the event that a provider discovers a significant omission of costs, it may
file an amended cost report at any time prior to the due date of its next
annual cost report. After that time, the cost report cannot be amended for cost
omissions. Amended cost reports shall be subject to the same requirements as
other cost reports, and will be the only accepted means to claim omitted costs.
Rate increases resulting from submission of omitted costs will not be
retroactive.
(2) Providers of
skilled nursing care that do not file cost reports required in this section or
do not file the cost reports in a timely manner as provided in Medicare
Principles of Reimbursement, in effect October 1, 1984, may be subject to
sanctions as provided by the Medicare Principles of Reimbursement. Providers of
skilled nursing care who fail to file cost reports for a specific period shall
be subject to penalties in accordance with state law.
(3) After a period of five years following
the implementation of Medicaid prospective payment for Level II nursing
facility services on October 1, 1996, amended or corrected Level II nursing
facility cost reports with claims for reimbursement for services prior to
October 1, 1996 shall not be accepted.
Notes
Authority: T.C.A. ยงยง 4-5-202, 12-4-301, 71-5-105, 71-5-109, and Executive Order No. 23.
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