Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1187 - NURSING FACILITY SERVICES
Subchapter E - ALLOWABLE PROGRAM COSTS AND POLICIES
Section 1187.55 - Selected resident care and other resident related cost policies
Universal Citation: 55 PA Code ยง 1187.55
Current through Register Vol. 54, No. 44, November 2, 2024
Policies for selected resident care and other resident related costs are as follows:
(1) Drug services.
(i) The costs
of nonlegend drugs, such as laxatives, aspirin and antacids that are provided
directly by a nursing facility from its own supply are allowable costs if the
drugs are medically necessary and administered according to a physician's
written order or prescription.
(ii)
Costs of legend drugs are not allowable costs.
(iii) Costs related to a pharmacy consultant
shall be reported as general administrative costs on the cost report.
(2) Practitioner and therapy services.
(i) Costs for
practitioner and therapy services which are provided on a contract or salary
basis by the nursing facility are allowable costs.
(ii) The direct and indirect costs associated
with noncompensable cost centers, such as a pharmacy or space rented or used by
an independent practitioner, are not allowable costs.
(3) Volunteer and donated services of individuals.
(i) The actual costs
that a nursing facility incurs when the nursing facility regularly uses the
services of volunteer or religious organizations in positions that are normally
held by full-time employes who provide resident care or assist with the
operation of the nursing facility are allowable costs. The following conditions
and limitations apply:
(A) The costs shall be
limited to the fair market value of customary compensation of full-time
personnel who perform similar services.
(B) The costs shall be based on regular
working hours, excluding overtime.
(C) The actual costs for these services shall
be supported by substantiating documentation.
(D) The costs will be reimbursed as part of
the net operating costs.
(ii) The Department will recognize costs as
allowable for nonpaid workers only if the following conditions are met:
(A) The nonpaid workers shall be members of
an organization of nonpaid workers.
(B) Membership of a nonpaid worker in the
organization shall be substantiated by adequate documentation in the files of
the organization of nonpaid workers.
(C) A legally enforceable agreement between
the nursing facility and the organization of nonpaid workers shall exist and
establish the nursing facility's obligation to remunerate the organization for
services rendered. If the nursing facility's legal obligation to pay the
organization of nonpaid workers is nullified by an offsetting legal obligation
by the organization of nonpaid workers to pay or make a contribution to the
nursing facility of all or part of the salary liability, the amount paid or
contributed by the organization of nonpaid workers is not an allowable
cost.
(iii) A payment
made by the organization of nonpaid workers to the nursing facility for the
nonpaid workers' maintenance, perquisites or fringe benefits shall be used as
an offset to the total of the cost actually incurred by the nursing
facility.
(iv) Staff services
relating to the use of volunteer workers are allowable costs.
(4) Pastoral services.
(i) Salary costs for
pastoral services rendered directly to residents by professional staff employed
by, or under contract with, the nursing facility are allowable costs.
(ii) Costs for a chaplaincy training program
and pastoral housing are not allowable costs.
This section cited in 55 Pa. Code § 1187.55a (relating to clarification of the term "written"-statement of policy); and 55 Pa. Code § 1187.59 (relating to nonallowable costs).
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