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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 22. HEALTH |
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SubTilte 22-B. PUBLIC HEALTH AND MEDICINE |
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Chapter 22-B55. STANDARDS FOR PREPAID PROVIDERS QUALIFYING TO SERVE DISTRICT OF COLUMBIA MEDICAID RECIPIENTS |
Section 22-B5503. AUDIT AND REPORTING REQUIREMENTS
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5503.1 Each QO shall annually file a financial statement, verified by at least two (2) principal officers within ninety (90) days after the close of its fiscal year.
5503.2 The QO shall have the financial statement described in §5503.1 audited by an independent certified public accountant.
5503.3 The audited financial statement shall give a clear indication of both total expenses and revenues and those attributable to Medicaid enrollees.
5503.4 The QO shall, upon the Department’s request, assist any accountant chosen by the Department to verify the audit report.
5503.5 The Department may inspect and audit any financial records of a QO or its subcontractors relating to the QO’s ability to bear the risk of potential financial loss.
5503.6 Annual audit reports and records shall be retained by the QO for a period of five (5) years after the latest date for which the record is applicable.
5503.7 If any litigation, claim, negotiation, audit, or other action involving the records described in §5503.6 has been started before the expiration of the five (5) year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five (5) year period, whichever is later.
5503.8 Each QO shall submit quarterly summaries of program utilization under its Medicaid contract that give the following information for each Medicaid eligibility category:
(a)The total member months in the quarter;
(b)The number of new enrollees;
(c)The number of disenrollees;
(d)The total inpatient days incurred;
(e)The total physician visits provided;
(f)The total out-of-plan referrals; and
(g)The number of emergency room encounters.
5503.9 Each QO shall be required to prepare semiannual summaries of financial performance under its Medicaid contract in terms of total clinical expenditures incurred plus assigned contribution to overhead.
5503.10 The reports filed under §5503.9 shall only be used to negotiate prospectively for future rates of payment.
5503.11 The quarterly utilization summary and semiannual financial summary, shall be submitted to the Department within ninety (90) days after the close of the quarter of the six (6) month period.