Current through Register Vol. 54, No. 44, November 2, 2024
(a) An
annual payment adjustment will be made by the Department or facility based on
total audited costs related to the total Department interim claims for services
for the fiscal year and any interim cost settlement for the fiscal years paid
under subsection (c).
(b) For cost
reporting periods ending on or after October 1, 1985, if the total amount of MA
payment for interim claims for services during the fiscal year exceeds the
total audited costs, the Department will recover the overpaid amount from the
provider under §
1101.69(b)
(relating to overpayment-underpayment).
(c) During Fiscal Years 1992-1993, 1993-1994
and 1994-1995, the Department will pay facilities interim cost settlements on
acceptable year-end cost reports as follows:
(1) A facility's interim cost settlement will
be equal to 90% of the amount by which the facility's total adjusted allowable
costs for MA reported in the facility's acceptable fiscal year-end cost report
exceed the amount of MA interim payments received by the facility attributable
to the fiscal period covered by the cost report.
(2) For the purpose of paragraph (1),
"adjusted allowable costs" means the facility's total reported costs for MA as
adjusted for the following limitations:
(i)
The applicable ceiling on net operating costs, as stated in §
1181.68(b)
(relating to upper limits of payment).
(ii) The per bed ceiling on allowable
depreciation and interest costs as stated in §§
1181.259(s) and
1181.260(k)
(relating to depreciation allowance; and interest allowance) in effect on
February 1, 1993, or in effect during the cost report period, whichever is
greater.
(iii) The moratorium on
reimbursement of depreciation and interest costs as stated in §§
1181.259(r) and 1181.260(a).
(iv)
The Medicare rate and private pay rate upper limitations on payment, as stated
in §
1181.68(a)(1) and
(2). In adjusting the facility's reported
costs for the Medicare rate and the private pay rate limitations, the
Department will apply the facility's most recent Medicare and private pay rates
reported on the MA 58 form filed with the fiscal year end cost report on which
the interim cost settlement is based.
(3) Interim cost settlements will not be paid
on the basis of interim or final cost reports.
(4) An interim cost settlement will not be
paid to a facility which has filed an interim cost report for the fiscal period
covered by the interim cost settlement unless the facility waives its rights to
a revised interim rate for the fiscal period.
See 22 Pa.B. 3749 (July 18, 1992) for nursing home
pooling provisions.
The provisions of this §1181.69 amended under sections
201, 403 and 443.1(2) and (3) of the Public Welfare Code (62 P. S. §§
201,
403 and
443.1(2) and
(3)).
This section cited in 55 Pa. Code §
1181.52 (relating to payment
conditions); and 55 Pa. Code §
1181.101 (relating to facility's
right to a hearing).
