N.Y. Comp. Codes R. & Regs. tit. 14 § 506.8

Current through Register Vol. 46, No. 45, November 2, 2024

Section 506.8 - Audits

(a) Each provider of intensive case management, supportive case management or blended ICM/SCM case management services shall maintain the records which formed the basis of the statistical and financial reports submitted to the commissioner for six years from the date on which the reports were submitted to the commissioner, or for such longer period as may be required under Federal law.

(b) All such records shall be subject to audit for a period of six years from the date on which all required reports were filed with the commissioner or the date on which such reports were due, whichever is later

(c) On-site audits or desk audits shall be conducted by the commissioner at a time and place and in a manner to be determined by the commissioner.

(d) The commissioner may enter into agreements with other organizations or agencies having audit responsibilities to audit the financial and statistical records of any provider of intensive case management, supportive case management or blended ICM/SCM case management services.

(e) At the conclusion of the audit, the provider of intensive case management, supportive case management or blended ICM/SCM case management services shall be afforded an opportunity to submit additional documentation to the commissioner. After receipt and review of such additional documentation, a copy of the audit findings and notice of any proposed rate revision shall be sent to the provider of intensive case management, support case management or blended ICM/SCM case management services.

(f) Any proposed rate revisions resulting from the implementation of audit findings shall be final unless within 30 days of receipt of the proposed rate revision the provider of intensive case management, supportive case management or blended ICM/SCM case management services requests a hearing on factual issues. Requests for hearing, and the conduct of such hearings, shall be pursuant to Part 503 of this Title.

(g) Revisions to rates determined in accordance with the provisions of this section shall be retroactive to the rate year covered by the audit. Any resulting overpayment shall be satisfied by either retroactive adjustments of the provisional rate paid, based on the period audited, or prospective adjustment of the current certified rate at the discretion of the commissioner.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 506.8