§7–306.1. IN EFFECT
** IN EFFECT UNTIL CONTINGENCY MET PER CHAPTER 648 OF 2014**
(a) The Administration shall develop and implement a funding system for the distribution of State funds to private providers that are under contract with the Administration to provide community–based services to individuals with disability in accordance with the State plan.
(b) Funds received for services that are fee–for–service or that have rates set by regulation shall be subject to recovery by the Administration only for the following purposes:
(1) Client attendance;
(2) Client fees; or
(3) Sanctions allowed through regulations.
(c) (1) Under the funding system developed under subsection (a) of this section, the Administration shall notify each private provider at least 30 days before the beginning of the fiscal year of the billing rate or amount of funds to be paid to the provider for the provision of community–based services to an individual with developmental disability or a group of individuals with developmental disability for the coming fiscal year.
(2) For rates that are set in regulation, the Administration shall include the cost centers used to determine the funding amount of each rate.
(3) (i) A private provider may request an administrative resolution of a billing rate set under paragraph (1) of this subsection except for rates set in regulation.
(ii) Within 60 days after receipt of the provider’s request, the Administration shall make a decision on the request for an administrative resolution.
(iii) If an administrative resolution cannot be reached between the provider and the Administration, the provider may request an evidentiary hearing or an oral hearing in accordance with regulations of the Department.
(d) Subject to the provisions of subsections (e), (f), and (g) of this section, the Administration shall provide payment to private providers for the services provided from the funds designated in subsection (c) of this section in accordance with the following payment schedule:
(1) On or before the third business day of the fiscal quarter beginning July 1, 33% of the total annual amount to be paid to the provider;
(2) On or before the third business day of the fiscal quarter beginning October 1, 25% of the total annual amount to be paid to the provider;
(3) On or before the third business day of the fiscal quarter beginning January 1, 25% of the total annual amount to be paid to the provider; and
(4) On or before the third business day of the fiscal quarter beginning April 1, 17% of the total annual amount to be paid to the provider.
(e) The Administration may deviate from the payment schedule provided under subsection (d) of this section for any provider:
(1) That is reimbursed through the fee payment system and fails to submit properly completed program attendance reports within 15 days of the beginning of each month;
(2) That provides services under the medical assistance program and fails to submit the designated forms used by the medical assistance program to claim federal fund participation within 30 days after the end of each month; or
(3) That fails to submit a cost report for rate–based payment systems or wage surveys as required under subsection (k) of this section.
(f) A deviation from the payment schedule as provided under subsection (e) of this section may occur only if the Administration has:
(1) Advised the provider that:
(i) An attendance report which has been submitted on time is in need of correction;
(ii) A designated medical assistance form which has been submitted on time is in need of correction;
(iii) A cost report for rate–based payment systems has not been submitted within 6 months from the close of the fiscal year or, if submitted, is in need of correction; or
(iv) A wage survey requested under subsection (l) of this section has not been submitted by the later of 60 days from the date of receipt of the request or within 60 days after the last day of the pay period for which the data was requested or, if submitted, is in need of correction;
(2) Allowed the provider at least 5 working days to submit, resubmit or correct the report or form; and
(3) Not in any way contributed to the delay of or error on a report or form.
(g) The amount of a reduction of payments to a provider pursuant to subsections (e) and (f) of this section may not:
(1) Exceed the amount of lost federal revenue attributable to the delay or error; or
(2) In the case of cost reports for rate–based payment systems or wage surveys, exceed $500 per day per report for each day the report is not submitted past the given due date or corrected.
(h) The Administration:
(1) Shall place sufficient funds in a specially designated account with the Office of the Comptroller to meet its financial obligations under subsection (d) of this section;
(2) Shall disburse funds from the account in accordance with the payment schedule provided in subsection (d) of this section;
(3) May not use the funds in the account for any other purpose except for the purpose of reimbursing private providers for the provision of community–based services to individuals with developmental disability;
(4) Within 1 year after receipt of a private provider’s year–end report and cost report for rate–based payment systems, shall reconcile the report and shall provide the provider with a written approval of the report or a written explanation of any items in dispute; and
(5) Shall conduct an audit of each private provider every 4 years.
(i) The Administration shall accept as final the private provider’s year–end report and cost report for rate–based payment systems if:
(1) The Administration fails to provide written approval or a written explanation of any items in dispute within 1 year after receiving the report; or
(2) The Administration fails to reconcile the year–end report and cost report for rate–based payment systems within 1 year after receiving the report.
(j) If the Administration fails to conduct an audit of a private provider as required in subsection (h)(5) of this section, the Administration may not audit the private provider for any fiscal year that began more than 48 months before the Administration’s notification of audit, unless the Administration suspects fraud or misappropriation of funds.
(k) Private providers shall provide the year–end report to the Administration no later than 6 months after the end of the State fiscal year.
(l) Private providers shall submit to the Administration:
(1) Cost reports for rate–based payment systems no later than 6 months after the end of the State fiscal year; and
(2) Wage surveys by the later of:
(i) 60 days after the last day of the pay period for which the data is requested; or
(ii) 60 days after receipt of a request from the Administration for wage survey information.