Financial Compliance Audits of Medicaid Prepaid Plans

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-8.800Financial Compliance Audits of Medicaid Prepaid Plans

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 39, No. 101, May 23, 2013 issue of the Florida Administrative Register.

 

59G-8.800 Financial Compliance Audits of Medicaid Prepaid Plans.

(1) Pursuant to Fla. Stat. § 409.967(3)(b), Florida Statutes (F.S.), the Agency for Health Care Administration (hereafter referred to as Agency) shall contract with independent certified public accountants to conduct compliance audits of Florida Medicaid pPrepaid hHealth pPlans.

(a) Certified public accountants that participate in the preparation of a plan’s financial audits or annual statements submitted by the plan pursuant to 409.967(3)(a)1. and 2., F.S., will be deemed to have a conflict of interest and are not independent regarding preparation of a compliance audit for that plan pursuant to 409.967(3)(c)1., F.S. Any vendor selected by the agency to conduct an audit may not have a conflict of interest that might affect its ability to perform its responsibilities with respect to an audit.

(b) The Agency will procure, pursuant to Chapter 287, F.S., services from Florida licensed certified public accountants to perform compliance audits required by 409.967(3)(b), F.S. Rates established for the services utilized for compliance audits will be established through the procurement process and will be comparable to market rates the Agency pays for similar accounting and auditing services. The Agency will exercise due diligence in ensuring the rates charged to the Florida Medicaid Prepaid Health Plan being audited are comparable with rates the Agency pays to other certified public accountants for comparable audits.

(c) A Florida Medicaid prepaid health plan audited pursuant to 409.967(3)(b), F.S., must pay the Agency costs, charges, and expenses for the compliance audit at the rates established by the Agency pursuant to the procurement process. The rates established by the Agency for compliance audits will include: Each Florida Medicaid Prepaid Health Plan audited shall pay to the Agency, for the expenses of the audit described in Fla. Stat § 409.967(3)(b), a rate established by the Agency through a competitive process used for selection of the vendor. The rate shall account for costs directly related to the audit as listed in Fla. Stat. § 409.967(3)(c)3., and shall consist of three components:

1.(1) Ttravel reimbursement, in accordance with Fla. Stat. § 112.061;

2.(2) the CPA’s professional Ccompensation of professional and support services.; and

3.(3) Tthe Agency’s administrative costs directly related to the audit.

Payment is due to the Agency within 15 days from the date the Agency presents the detailed account described in Fla. Stat. § 409.967(3)(c)3.

(d) All moneys collected from Florida Medicaid Prepaid Health Plans for such audits shall be deposited into the Agency’s Grants and Donations Trust Fund, and the Agency may make deposits into such fund from moneys appropriated for the operation of the Agency.

(2) The Agency will prepare and provide each Florida Medicaid prepaid health plan audited a detailed statement of the costs, charges, and expenses for the audit. A plan must pay the Agency the costs, charges, and expenses identified in the detailed statement within 15 days of the Agency’s presentation of the statement to the plan. Audits conducted pursuant to Fla. Stat. § 409.967 must be conducted by an independent certified public accountant. The certified public accountant must meet the standards of independence contained within “Standards for Determining Independence in the Practice of Public Accountancy for CPAs Practicing Public Accountancy in the State of Florida,” (effective Dec. 31, 2004) (hereinafter the “Standards for Independence”), which is incorporated by reference into this rule. A copy of the “Standards for Independence” can be found at http://ahca.myflorida.com/Medicaid/statewide_mc/index.shtml#SMMC_Home. In order to be considered independent, a certified public accountant must comply with the requirements set out in the “Standards for Independence.” A certified public accountant who conducts the annual financial audit in Fla. Stat. § 409.967(3)(a)1. is deemed to have a conflict of interest with respect to the compliance audit in Fla. Stat. § 409.967(3)(b).

Rulemaking Authority 409.961, 409.967 FS. Law Implemented 409.967 FS. History–New_________.