Current through Register Vol. 53, No. 52, December 30, 2023
(a) This subchapter
sets forth principles for determining the allowable costs of nursing
facilities.
(b)
The
Medicare Provider Reimbursement Manual (CMS Pub. 15-1) and the Federal
regulations in 42 CFR Part 489 (relating to provider and supplier agreements)
appropriate to the reimbursement for nursing facility services under the
Medicare Program are a supplement to this chapter. If a cost is included in
this subchapter as allowable, the CMS Pub. 15-1 and applicable Federal
regulations may be used as a source for more detailed information on that cost.
The CMS Pub. 15-1 and applicable Federal regulations will not be used for a
cost that is nonallowable either by a statement to that effect in this chapter
or because the cost is not addressed in this chapter or in the MA-11. The CMS
Pub. 15-1 or applicable Federal regulations will not be used to alter the
treatment of a cost provided for in this subchapter or the MA-11.
(c) The Department's payment rate for nursing
facility services to eligible residents in participating nursing facilities
includes allowable costs for routine services. Routine services may include the
following:
(1) Regular room, dietary and
nursing services, social services and other services required to meet
certification standards, medical and surgical supplies and the use of equipment
and facilities.
(2) General nursing
services, including administration of oxygen and related medications, hand
feeding, incontinency care, tray service and enemas.
(3) Items furnished routinely and uniformly
to residents, such as resident gowns, water pitchers, basins and
bedpans.
(4) Items furnished,
distributed to residents or used individually by residents in small quantities
such as alcohol, applicators, cotton balls, bandaids, antacids, aspirin (and
other nonlegend drugs ordinarily kept on hand), suppositories and tongue
depressors.
(5) Reusable items
furnished to residents, such as ice bags, bed rails, canes, crutches, walkers,
wheelchairs, traction equipment and other durable medical equipment.
(6) Special dietary supplements used for tube
feeding or oral feeding, such as elemental high nitrogen diet, even if written
as a prescription item by a physician.
(7) Basic laundry services.
(8) Nonemergency transportation.
(9) Beauty and barber services.
(10) Other special medical services of a
rehabilitative, restorative or maintenance nature, designed to restore or
maintain the resident's physical and social capacities.
(d) Nursing facilities will receive payment
for allowable costs in four general cost centers:
(1) Resident care costs.
(2) Other resident related costs.
(3) Administrative costs.
(4) Capital costs.
(e) Within the limits of this subchapter,
allowable costs for purposes of cost reporting include those costs necessary to
provide nursing facility services. These may include costs related to the
following:
(1)
Resident care
costs.
(i) Nursing.
(ii) Director of nursing.
(iii) Related clerical staff.
(iv) Practitioners.
(v) Medical director.
(vi) Utilization and medical
review.
(vii) Social
services.
(viii) Resident
activities.
(ix) Volunteer
services.
(x) Over-the-counter
drugs.
(xi) Medical
supplies.
(xii) Physical,
occupational and speech therapy.
(xiii) Oxygen.
(xiv) Beauty and barber.
(xv) Supplies and minor movable property
acquired during cost report periods beginning on or after January 1, 2001, used
in a nursing facility in the course of providing a service or engaging in an
activity identified in this paragraph.
(2)
Other resident related
costs.
(i) Dietary, including food,
food preparation, food service, and kitchen and dining supplies.
(ii) Laundry and linens.
(iii) Housekeeping.
(iv) Plant operation and maintenance,
including the repair, maintenance and service of movable property.
(v) Supplies and minor movable property
acquired during cost report periods beginning on or after January 1, 2001, used
in a nursing facility in the course of providing a service or engaging in an
activity identified in this paragraph.
(3)
Administrative costs.
(i) Administrator.
(ii) Office personnel.
(iii) Management fees.
(iv) Home office costs.
(v) Professional services.
(vi) Determination of eligibility.
(vii) Advertising.
(viii) Travel/entertainment.
(ix) Telephone.
(x) Insurance.
(xi) Interest other than that disallowed
under §
1187.59(a)(24)
(relating to nonallowable costs).
(xii) Legal fees.
(xiii) Amortization-administrative
costs.
(xiv) Supplies and minor
movable property acquired during cost report periods beginning on or after
January 1, 2001, used in a nursing facility in connection with an activity
identified in this paragraph.
(4)
Capital costs.
(i) Assigned cost of fixed
property.
(ii) Acquisition cost of
major movable property.
(iii) Real
estate tax cost.
The
provisions of this §
1187.51 amended February 8, 2002,
effective 7/1/2001, 32 Pa.B. 734;
amended June 23, 2006, effective 7/1/2006, 36 Pa.B. 3207; amended November 26,
2010, effective 11/27/2010, 40
Pa.B. 6782.
The provisions of this §
1187.51 amended under sections
201(2), 206(2), 403(b) and 443.1(5) of the Public Welfare Code (62 P.S.
§§
201(2),
206(2), 403(b) and
443.1(5)).
This section cited in 55 Pa. Code §
1187.57 (relating to selected
capital cost policies).
