Documentation and Audit

(1) Hospitals and Community Health Centers must maintain auditable records of their activities made in compliance with the criteria and requirements of regulation 114.6 CMR 10.00, including documentation of Free Care accounts and Free Care applications. Hospitals must also documenttheir activities as required in 114.6 CMR 7.00. Community Health Centers must also document their activities as required in 114.6 CMR 8.00. (2) The Division may, through various mechanisms, audit Free Care accounts of Acute Hospitals and Community Health Centers to determine compliance with this section and shall deny Pool payment for any audited account that fails tocomply. Theseaudit mechanisms may include verification of Free Care eligibility and ensuring that other coverage options are utilized fully before Free Care is granted. (3) The Division may disallow payment for services covered by MassHealth, another program of public assistance, or other health insurance plan in which the patient is enrolled. (4) The Division will disallow payment from the Pool for non-Medically Necessary Services. (5) The Division will determine the level of payment that will be disallowed from the Pool using a methodology to appropriately extrapolate the amount of audited accountsthatfailto complywith 114.6 CMR 10.00 as compared to all of the Hospital’s or Community Health Center’s Free Care accounts. (6) A Hospital aggrieved by any action or failure to act by the Division may seek a review pursuant to the provisions of 114.6 CMR 7.05. (7) A Community Health Center aggrieved by any action or failure to act by the Division may seek a review pursuant to the provisions of 114.6 CMR 8.00.