§ 53-6-1503 — Retroactive Adjustment And Settlement Of Cost Report

53-6-1503 . Retroactive adjustment and settlement of cost report. (1) (a) To reimburse a provider as quickly as possible, the department of public health and human services shall perform a tentative retroactive adjustment when a cost report is received by the applicable medicare administrative contractor.
(b) Costs must be accepted as reported except for obvious errors or inconsistencies, subject to adjustment by a later audit.
(c) The department shall make an interim settlement of the report and, if applicable, payment to the provider within 240 days after receipt of the cost report by the medicare administrative contractor or within 30 days after receipt of the interim medicaid cost settlement from the medicare administrative contractor, whichever occurs sooner.
(d) In the event of an overpayment, the provider has 60 days from the date of the initial notification indicated by the interim cost settlement to repay the amount of the overpayment, or to have an agreed upon repayment schedule.
(2) (a) Upon receipt of the final desk review or audit of the cost report by the applicable medicare administrative contractor, the department shall perform a final retroactive adjustment and, if applicable, a final settlement of the cost report.
(b) In the event of an overpayment, the provider has 60 days from the date of the initial notification to repay the amount of the overpayment or to have an agreed upon repayment schedule. In the event of an underpayment, the department will reimburse the provider within 90 days from the date of the initial notification to the provider.
(3) As used in this section, "medicare administrative contractor" has the same meaning as provided in 42 CFR 421.401 and also includes an intermediary as defined in 42 CFR 421.3.

Legislative History

En. Sec. 3, Ch. 518, L. 2025.