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
REIMBURSEMENT PRINCIPLES
Section 1181.212 - General principles

Universal Citation: 55 PA Code ยง 1181.212

Current through Register Vol. 54, No. 44, November 2, 2024

(a) 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.

(b) Total allowable costs of a facility will be apportioned between third-party payors and other patients so that, within the limits of this subchapter, the share borne by MA under Title XIX of the Public Health Service Act, 42 U.S.C. Chapter 6A, Subchapter XIX is based upon those actual services and costs related to MA recipients.

(c) Within the limits of this subchapter, allowable costs include those costs necessary to provide skilled or intermediate care. These may include costs related to all of the following:

(1) Dietary and food.

(2) Laundry.

(3) Housekeeping.

(4) Plant operation and maintenance.

(5) Nursing.

(6) Director of nursing.

(7) Related clerical staff.

(8) Practitioners.

(9) Medical director.

(10) Utilization and medical review.

(11) Social services.

(12) Patient activities.

(13) Volunteer services.

(14) Over-the-counter drugs.

(15) Medical supplies.

(16) Physical, occupational and speech therapy.

(17) Oxygen.

(18) Rent.

(19) Amortization.

(20) Other interest.

(21) Insurance.

(22) Real estate taxes.

(23) Equipment rental.

(24) Depreciation.

(25) Interest on capital indebtedness.

(d) In certain cases under MA principles, there may be more than one method for handling a cost item. In these cases the method initially elected by the provider shall be followed consistently in subsequent reporting periods except as provided in this subchapter.

Disclaimer: These regulations may not be the most recent version. Pennsylvania may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.