Current through Register Vol. 54, No. 44, November 2, 2024
(a) A nursing
facility shall use the direct allocation method of cost-finding. The costs of
ancillary and administrative services shall be apportioned directly to the
appropriate level of care based on appropriate statistical data.
(b) A facility's direct or indirect allowable
costs related to patient care will be considered in the finding and allocation
of costs to the MA Program for its eligible recipients. Total allowable costs
of a facility shall be apportioned between third-party payors and other
patients so that the share borne by MA is based upon actual services and costs
related to MA patients. For purposes of MA reimbursement, the return on net
equity and net worth is not reimbursable.
(c) The Department will recognize
depreciation and interest as an allowable cost for general and county nursing
facilities subject to the following conditions:
(1) Depreciation and interest on new or
additional beds is an allowable cost only if one of the following applies:
(i) The facility was issued either a Section
1122 approval or letter of nonreviewability under 28 Pa. Code Chapter 301
(relating to limitation on Federal participation for capital expenditures) or a
Certificate of Need or letter of nonreviewability under 28 Pa. Code Chapter 401
(relating to Certificate of Need Program) for the project by the Department of
Health no later than August 31, 1982.
(ii) The facility was issued a Certificate of
Need or letter of nonreviewability under 28 Pa. Code Chapter 401 for the
construction of a nursing facility, and there was no nursing facility,
including county, private or hospital-based, located within the
county.
(2) The
Department will not recognize depreciation and interest as allowable costs if
the facility does not substantially implement the project as defined at 28 Pa.
Code §401.5(m)(3)
(relating to Certificate of Need) within the effective period of the original
Section 1122 approval or the original Certificate of Need.
(3) Depreciation and interest on replacement
beds is an allowable cost only if the facility was issued a Certificate of Need
or a letter of nonreviewability by the Department of Health.
(4) Allowable depreciation and interest on
capital indebtedness will be recognized on debt service incurred to finance a
maximum cost per bed of $22,000. The $22,000 per bed limit does not include the
cost of movable equipment. Allowable depreciation and interest will be
calculated by the straight line method of accounting.
(d) Allowable operating costs for a general
nursing facility including hospital-based and special rehabilitation
facilities, shall be determined subject to the following:
(1) The Department's Manual for Allowable
Cost Reimbursement for Skilled Nursing and Intermediate Care
Facilities.
(2) The HIM-15, except
that if the Department's Manual and the HIM-15 differ, the Department's Manual
applies.
(3) The MSA or non-MSA
group ceilings if applicable.
(e) Allowable operating costs for a county
nursing facility will be determined under the following:
(1) The Department's Manual for
Allowable Cost Reimbursement for Skilled Nursing and Intermediate Care
Facilities is used for cost-finding.
(2) HIM-15 will used as a supplement to the
Department's Manual for Allowable Cost Reimbursement for Skilled
Nursing and Intermediate Care Facilities with respect to allowable
costs. HIM-15 may not be construed to recognize an allowable cost which
otherwise is not included or is excluded in the Department's Manual for
Allowable Cost Reimbursement for Skilled Nursing and Intermediate Care
Facilities.
(3) The
facility's net operating per diem is subject to the MSA or non-MSA group
ceiling for county facilities.
(4)
The Department will deduct from the State share of the allowable operating
costs of county facilities the administrative expense the Department incurs in
determining the allowable operating costs of a county facility.
(f) Allowable costs for an
intermediate care facility for the mentally retarded shall be determined as
follows:
(1) For State-operated intermediate
care facilities for the mentally retarded, allowable costs are determined by
HIM-15.
(2) For non-State-operated
intermediate care facilities for the mentally retarded, allowable costs are
determined by Subchapter C (Reserved).
(g) The allowable costs of a psychiatric
transitional facility and other State-operated nursing facility other than an
intermediate care facility for the mentally retarded will be determined in
accordance with the HIM-15 and within the limits of their approved
budgets.
(h) For a nursing
facility, the Department's reimbursement for depreciation, interest and other
costs related to the negotiation or settlement of the sale or purchase of a
capital asset that undergoes a transfer of ownership either on or after July
18, 1984, will be determined under paragraphs (1) and (2). Paragraph (1) does
not apply to an asset that undergoes a transfer of ownership either on or after
July 18, 1984 under an enforceable agreement that was entered into prior to
July 18, 1984.
(1) The cost basis that will
be used to establish the allowable depreciation and interest for an asset that
undergoes a transfer of ownership on or after July 18, 1984 will be the lesser
of the remaining allowable cost basis of the asset to the owner of record on or
after July 18, 1984, or, in the case of an asset not in existence as of that
date, the first owner of record of the asset after that date, or the allowable
cost basis of the asset to the new owner.
(2) The Department will not recognize as
allowable, a cost including legal fees, travel costs and the costs of
feasibility studies, attributable to the negotiation or settlement of the sale
or purchase of a capital asset-by acquisition or merger-for which a payment has
previously been made under Title XVIII of the Social Security Act
(42 U.S.C.A. §§
1395-1395xx).
The provisions of this §1181.65 amended under sections 201
and 443.1 of the Public Welfare Code (62 P. S. §§
201 and
443.1).
This section cited in 55 Pa. Code §
1181.52 (relating to payment
conditions); and 55 Pa. Code §
1181.259 (relating to depreciation
allowance).
