Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1181 - NURSING FACILITY CARE
Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES
OTHER COST ITEMS
Section 1181.254 - Medicare Part B type services
Universal Citation: 55 PA Code ยง 1181.254
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Facilities shall have the option of using one of two methods of dealing with Medicare Part B services provided by nursing facility owners or operators to MA recipients:
(1)
Option 1.
The nursing facility may exclude from its cost report any operating and capital
costs incurred in, and any income derived from, the provision of Medicare Part
B services. The nursing facility shall attach, to the cost report the facility
submits to the Department, a copy of the cost report the facility submits to
Medicare for the Part B services and a copy of the Medicare final audit,
including audit adjustments. If final audits are not available, the Department
will exclude any operating or capital cost associated with providing the
Medicare Part B service.
(2)
Option 2. The nursing facility may elect, through advance
written notification to the Department, to include in its cost report the
operating and capital costs incurred in, and the income derived from, the
provision of Medicare Part B services. If the nursing facility elects this
option, the facility's fiscal year must coincide with that of the Department;
and the facility may not change its methodology for Medicare Part B services
for the duration of the fiscal year. The Department, at the final settlement,
will take the following steps in determining its reimbursement to the facility:
(i) The Department will identify the
percentage of the total operating costs represented by the Medicare Part B
services and reduce the ceiling on net operating costs for the facility by that
percentage.
(ii) The Department
will identify and deduct from the total capital costs of the facility the
percentage of depreciation and interest costs associated with the provision of
Medicare Part B services.
(iii) The
Department will apply any revenue received by the facility from Medicare for
providing the Part B service as an adjustment to the cost of providing these
services before the Department adjusts for the ceiling on net operating costs
for the facility.
(3) If
the facility did not provide advance written notification to the Department of
the facility's election of Option 2 and the facility's cost report contains
costs associated with the provision of Medicare Part B services, the Department
will credit against the total reimbursement due any revenue the facility
received from Medicare for the Part B services rendered to the facility's
Medical Assistance recipients.
(b) The cost of providing Medicare Part B type services to non-Medicare Part B eligible recipients which are otherwise allowable costs under this part should be reported as provided elsewhere in this subchapter.
This section cited in 55 Pa. Code § 1181.254a (relating to Medicare Part B adjustments-statement of policy).
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