(a) (1) The department shall perform or have performed provider program and fiscal audits as needed. Provider programs shall maintain all child-specific, programmatic, personnel, fiscal, and other information or records affecting ratesetting and AFDC-FC payments for a period of not less than five years, except that information and records shall be kept for a longer period of time if otherwise required by law.
(2) Provider fiscal audits shall be conducted pursuant to Part 200 (commencing with Section 200.0) of Chapter II of Subtitle A of Title 2 of the Code of Federal Regulations, as implemented by the United States Department of Health and Human Services in Part 75 (commencing with Section 75.1) of Title 45 of the Code of Federal Regulations, including uniform administrative requirements, cost principles, and audit requirements, as specifically implemented in Section 75.106 of Title 45 of the Code of Federal Regulations.
(3) A provider may request a hearing of the department’s program or fiscal audit determination under this section no later than 30 days after the date the department issues its audit determination. A provider may request a hearing to examine any disputed audit determination, including, but not limited to, an audit finding regarding the provider’s internal controls, board of directors oversight, program operation, or a finding that results in an overpayment. The department’s audit determination shall be final if the provider does not request a hearing within the prescribed time. Within 60 days of receipt of the request for hearing, the department shall conduct a hearing on the audit determination. The standard of proof shall be the preponderance of the evidence and the burden of proof shall be on the department. The hearing officer shall issue the proposed decision within 45 days of the close of the evidentiary record. The department shall adopt, reject, or modify the proposed decision, or refer the matter back to the hearing officer for additional evidence or findings within 100 days of issuance of the proposed decision. If the department takes no action on the proposed decision within the prescribed time, the proposed decision shall take effect by operation of law.
(b) (1) The department shall develop regulations to require corrective action to a program’s or provider’s operation as a result of program or fiscal audit findings, to adjust the rate, and to recover any overpayments resulting from an overstatement of the projected level of care and services or overpayments or disallowed costs resulting from other audit findings.
(2) Any repeat fiscal audit findings may result in a monetary penalty or rate reduction, suspension, or termination of the provider’s rate in accordance with regulations adopted by the department, all-county letters, or similar written instructions.
(c) (1) In any audit conducted by the department, the department, or other public or private audit agency with which the department contracts, shall coordinate with the department’s licensing and ratesetting entities so that a consistent set of standards, rules, and auditing protocols are maintained. The department, or other public or private audit agency with which the department contracts, shall make available to all providers, in writing, any standards, rules, and auditing protocols to be used in those audits.
(2) The department shall provide exit interviews with providers, whenever deficiencies are found, and shall explain the deficiencies and permit providers an opportunity to respond. The department shall adopt regulations, all-county letters, or similar written directives specifying the procedure for the appeal of program and fiscal audit findings.
(d) Nothing in this section shall preclude the department from revoking the license of, or initiating legal proceedings against, a provider that has violated relevant laws and regulations.
(Amended by Stats. 2017, Ch. 732, Sec. 80. (AB 404) Effective January 1, 2018.)
Last modified: October 25, 2018