GroundRules
12VAC30-90-80: Time frames
Where this section sits in the code
- Title 12. Health
- Agency 30. Department of Medical Assistance Services
- Chapter 90. Methods and Standards for Establishing Payment Rates for Long-Term Care
- Part II. Nursing Home Payment System Subpart I General
- Article 8. Prospective Rates
Article 8
Prospective Rates
A. For cost reports filed on or after August 1, 1992, a prospective rate shall be determined by DMAS within 180 days of the receipt of a complete cost report. (See 12VAC30-90-70 A.) Rate adjustments shall be made retroactive to the first day of the provider's new cost reporting year. Where a field audit is necessary to set a prospective rate, DMAS shall have an additional 120 days to determine any appropriate adjustments to the prospective rate as a result of such field audit. This time period shall be extended if delays are attributed to the provider.
B. Subsequent to establishing the prospective rate DMAS shall conclude the desk audit of a providers' cost report and determine if further field audit activity is necessary. DMAS will seek repayment or make retroactive settlements when audit adjustments are made to costs claimed for reimbursement.
Collected 2026-09-14T04:51:01Z. Source file · JSON