Current through Register Vol. 54, No. 44, November 2, 2024
(a) The Department defines allowable
depreciation and interest costs for buildings and fixtures under Medicare cost
reimbursement principles in 42 CFR Part 413 (relating to principles of
reasonable cost reimbursement; payment for end-stage renal disease services).
Costs for major moveable equipment are not included in allowable depreciation
and interest costs for purposes of this section, but are included as part of
the prospective payment rate for operating costs.
(b) The Department will pay for allowable
depreciation and interest costs for buildings and fixtures-capital costs-as an
add-on percentage to each hospital's prospective payment rate.
(c) The add-on percentage is the
case-weighted Statewide average percentage of capital costs to operating costs.
The Department will determine the add-on percentage by the following method:
(1) For each hospital, determining MA
allowable acute care inpatient operating costs by subtracting MA allowable
acute care inpatient capital costs and MA allowable acute care inpatient
medical education costs from that hospital's total MA allowable acute care
inpatient costs.
(2) For each
hospital, dividing MA allowable acute care inpatient capital costs by that
hospital's MA allowable acute care inpatient operating costs.
(3) For each hospital, multiplying the ratio
determined under paragraph (2) by the number of reported MA acute care
inpatient cases at that hospital.
(4) Adding the products determined under
paragraph (3) for all hospitals.
(5) Dividing the sum obtained under paragraph
(4) by the Statewide number of reported MA acute care inpatient
cases.
(d) For Fiscal
Years 1993-94-1994-95, the Department has established an add-on percentage of
6.58%, on the basis of data reported on Hospital Cost Reports (MA 336) for
Fiscal Year 1990-91.
(e) Hospitals
that qualify as exceptional hospitals are eligible to apply for additional
reimbursement for capital costs.
(1) A
hospital will be identified as an exceptional hospital if one of the following
conditions exists:
(i) The hospital's total
number of reported acute care inpatient MA days for Fiscal Year 1984-85 is
greater than or equal to one standard deviation above the mean number of
reported acute inpatient MA days for the general hospitals enrolled in the MA
Program.
(ii) The hospital's ratio
of reported MA acute care inpatient days to its reported total acute inpatient
days for Fiscal Year 1984-85 is greater than or equal to one standard deviation
above the mean ratio of MA acute inpatient days to total acute inpatient days
for the general hospitals enrolled in the MA Program.
(2) A hospital that is determined to be
exceptional under paragraph (1) is eligible for additional reimbursement only
if it meets the following conditions:
(i) The
hospital requests additional reimbursement for the fiscal year by submitting
the information necessary for the Department to determine the hospital's
eligibility for additional reimbursement and the amount of the additional
reimbursement.
(ii) For the fiscal
year for which additional reimbursement is being requested, the hospital's
ratio of MA allowable acute care inpatient capital costs to the hospital's MA
total allowable acute care inpatient operating costs is equal to or greater
than 6.58%, the Statewide ratio of capital costs to total operating costs as
determined under subsections (c) and (d). For purposes of calculating a
hospital's individual ratio, the hospital's allowable inpatient acute care
capital costs shall include allowable inpatient capital costs for buildings and
fixtures placed in service prior to October 1, 1986, and allowable inpatient
acute care capital costs for projects placed in service on or after October 1,
1986, only if the project has a Certificate of Need which was approved on or
before June 30, 1987.
(3)
For exceptional hospitals that qualify for additional reimbursement in
accordance with paragraph (2), the Department will recognize as allowable
costs, the following:
(i) Allowable MA
inpatient acute care capital costs for buildings and fixtures placed in service
prior to October 1, 1986.
(ii)
Allowable MA inpatient acute care capital costs for buildings and fixtures
placed in service on or after October 1, 1986, only if the project has a
Certificate of Need approved on or before June 30, 1987.
(4) The Department will determine the interim
capital payment of an exceptional hospital using the cost information submitted
to the Department by the hospital as part of the hospital's exceptional payment
request.
(5) For exceptional
hospitals that qualify for additional reimbursement under paragraph (2), the
final payment amount will be the hospital's allowable MA inpatient acute care
capital costs determined under paragraph (3) subject to the following
limitations:
(i) If a hospital's inpatient
acute care occupancy rate is less than 70% for the fiscal year being audited,
the Department will reduce the hospital's full allowable MA acute care
inpatient capital costs by a factor determined by dividing the hospital's total
inpatient acute care days for the fiscal year by the product found by
multiplying the hospital's total available inpatient acute care bed days for
the fiscal year by 0.70. For purposes of calculating the hospital's occupancy
rate, the Department will include set up and staffed bed-days and patient days
related to units reimbursed under the prospective payment system in this
subchapter.
(ii) The Department
will compare a hospital's MA allowable acute care inpatient capital costs
incurred since October 1, 1986, to the Department's capital payments to the
hospital since October 1, 1986-hospital specific payments plus Statewide
percentage payments. If capital payments exceed capital costs, the Department
will deduct the difference from the hospital's MA allowable capital costs
incurred in the fiscal year for which additional reimbursement is
requested.
(6) The
Department will not offset interest income earned from funded depreciation
accounts in calculating additional reimbursement for MA allowable acute care
inpatient capital costs for hospitals that qualify as exceptional hospitals.
The funded depreciation account shall be established under Medicare principles
at 42 CFR Part 413.
The provisions of this §1163.53a amended under sections
201 and 443.1(1) of the Public Welfare Code (62 P. S. §§
201 and
443.1(1)).
This section cited in 55 Pa. Code §
1163.51 (relating to general
payment policy); and 55 Pa. Code §
1163.70 (relating to changes of
ownership or control).
