441—151.6 (232) District program reviews and audits. Each chief juvenile court officer shall establish procedures to review and audit the provision of the graduated sanction services to ensure that the requirements of this chapter and the contracts are met. The contract administrator accountant as established according to subrule 151.2(2) shall conduct the reviews and audits.
	   151.6(1) Schedule. The department shall notify each chief juvenile court officer or designee of the providers for which a review and audit must be conducted. The department shall identify in the notice all other judicial districts that have a contract with the provider.
	      a.    	 Annual on-site reviews and audits are required for any provider having one or more contracts with one or more judicial districts when the total annual value of the contracts is $100,000 or more.
	      b.    	 An on-site review and audit are required for each provider new to the district during the first year of the provider’s contract with the district when the total annual value of the provider’s contracts with the judicial district is $50,000 or more.
	      c.    	 Additional on-site reviews and audits are optional but may be considered appropriate by the chief juvenile court officer for providers, other than those described in paragraphs “a” and “b,” based on factors such as:
	       (1)  	 Length of time provider has been in business.
	       (2)  	 Amount of time provider has offered the services being purchased.
	       (3)  	 Type of service or program being purchased.
	       (4)  	 Amount of money involved in the contract.
	       (5)  	 Whether other governmental entities contract with this provider.
	       (6)  	 Findings from previous audits by the district, the department, or other entities such as the state auditor’s office.
	   151.6(2) Location. The reviews and audits shall take place at the sites where the program is operated and where necessary program and fiscal records are maintained.
	   151.6(3) Scope. The contract administrator accountant shall review and audit the provider’s service and financial records, including the client case records and case files, to ensure that the records contain the required documentation of the provision of the contracted service for each individual child for whom a claim is made. The reviews and audits shall include:
	      a.    	 Contact with the client.
	      b.    	 Review and audit of service billings and delivery of service.
	      c.    	 Review and audit of provider standards, staff qualifications, case files and case records, progress reports, and billing and payment records.
	   151.6(4) Repayment. The chief juvenile court officer may seek repayment of claims paid for noncovered services or for services for which documentation is not established.
	      a.    	 The chief juvenile court officer shall notify the provider in writing that a repayment is due. The written notice shall identify:
	       (1)  	 The claims;
	       (2)  	 The amounts of the claims that are not documented or substantiated; and
	       (3)  	 The amount of the repayment requested.
	      b.    	 The provider shall repay the department the difference between the amount received and the amount established through the audit, not to exceed the amount paid by the state, when:
	       (1)  	 The provider, upon audit, fails to verify or document the provision of covered services or costs in the amount for which a claim was paid or when the audit confirms claims paid for noncovered services; and
	       (2)  	 Juvenile court services or the department makes a request for repayment.
	      c.    	 The provider shall repay the department for the amount of any claims not supported by audit when:
	       (1)  	 The provider fails to maintain adequate records for auditing purposes or fails to make records available for audit or when the records, upon audit, fail to support the claims submitted; and
	       (2)  	 Juvenile court services or the department makes a request for repayment.
	      d.    	 A provider that is adversely affected by the request for repayment may appeal using procedures established in 441—Chapter 7.
	      e.    	 If the provider does not make payment within 60 days, the chief juvenile court officer shall submit to the department a copy of the notice to the provider for the department’s review and further action if necessary.
	   151.6(5) Report. Each contract administrator accountant shall submit to the department an annual report of the district’s review and audit activities for each state fiscal year.
	      a.    	 The annual report shall be submitted by December 31 following the end of the state fiscal year. This date may be extended upon the written request of the chief juvenile court officer to the department.
	      b.    	 The annual report shall include a report of the results of the review and audit for each required audit as well as a summary of the findings of the reviews and audits conducted on any other providers receiving state or federal funds in the state fiscal year.
[ARC 2435C, IAB 3/16/16, effective 5/1/16]