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Title: Section 86-4.6 - Audits

Effective Date


86-4.6 Audits.

(a) All fiscal and statistical records and reports shall be subject to audit, which must commence no later than six years from the date of filing or the date when due, whichever is later. There shall be no limitation in situations involving possible fraud or where the facility or its agent prevents the Department of Health or the Department of Social Services from performing an audit. Notification by either department to the facility of the department's intent to audit shall toll the six-year period.

(b) All underlying books, records and documentation which form the basis for fiscal and statistical reports filed by the facility with the department, shall be kept and maintained by the facility for not less than six years from the date of filing or the date upon which the fiscal and statistical records were to be filed, whichever date is later. Any rate of payment certified or approved by the commissioner prior to audit shall represent a provisional rate until an audit is performed and completed, at which time such rate or adjusted rate shall represent the audit rate.

(c) Rate revisions resulting from audits shall be retroactive to the audited rate period or periods. Any resulting overpayments or underpayments shall be corrected by retroactive adjustment of the provisional rate paid, based upon the period audited.

(d) The commissioner may promulgate rate revisions based upon audits completed by the department or other State agencies. Unless otherwise indicated, such audits shall not be considered final and shall not preclude conduct of a complete audit by the Department of Health, Department of Social Services or their agents.


VOLUME A-2 (Title 10)