The purpose of the rule is to implement the provisions found in s. 409.967(3)(c), F.S., regarding the achieved saving rebates. Statutory mandate requires any audit required under s.409.967(3), F.S., to be conducted by an independent certified ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-8.800Financial Compliance Audits of Medicaid Prepaid Plans

PURPOSE AND EFFECT: The purpose of the rule is to implement the provisions found in Section 409.967(3)(c), F.S., regarding the achieved saving rebates. Statutory mandate requires any audit required under Section 409.967(3), F.S., to be conducted by an independent certified public accountant who meets criteria specified by rule.

SUMMARY: Rule 59G-8.800, F.A.C., implements the provisions found in Section 409.967(3)(c), F.S., regarding the achieved saving rebates. Statutory mandate requires any audit required under Section 409.967(3), F.S., to be conducted by an independent certified public accountant who meets criteria specified by this rule.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: based on the requirements found in Section 120.541, F.S., the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 409.961 FS.

LAW IMPLEMENTED: 409.967 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: July 2, 2013, 10:00 a.m. – 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, FL 32308

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: Karen Chang at [phone] or by e-mail at: [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Karen Chang at [phone] or by e-mail at: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

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

(1) Pursuant to Fla. Stat. § 409.967, the Agency shall contract with independent certified public accountants to conduct compliance audits of Florida Medicaid Prepaid Health Plans.

(a) 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 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) 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) travel reimbursement, in accordance with Fla. Stat. § 112.061;

(2) the CPA’s professional compensation; and

(3) the 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) 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 FS. Law Implemented 409.967 FS. History–New_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Karen Chang

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 7, 2013

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: October 30, 2012