Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services › Section 129.04 - General Payment Provisions

Current through Register 1525, July 5, 2024
(1)
Reimbursement as Full Payment
. Each ICF that provides
			 services to publicly aided patients shall, as a condition of receipt of
			 payment, accept reimbursement at rates established by EOHHS as full payment and
			 discharge of all obligations to such individuals. There shall be no duplication
			 or supplementation of payment for services provided to publicly assisted
			 patients.
(2)
Reimbursement Limitation
. Reimbursement determined
			 under
			 101 CMR 129.00 for publicly
			 assisted patients shall not exceed that reimbursement that would result from
			 application of the Principles of Reimbursement of Provider Costs established
			 under
			 42 U.S.C. §§
									1395
et seq.,
the Medicare
			 Act.
(3)
Allowable
			 Costs
.
(a) Pursuant to the
			 requirements and rate and charge determination formulas of
			 101 CMR 129.00, ICFs shall
			 be reimbursed for allowable costs. These costs must be reasonable costs and
			 must be directly related to health care and services.
(b) Except as otherwise required in
			 101 CMR 129.00 and the
			 instructions to the ICF Cost Report, allowable costs for inpatient care and
			 services shall be determined in accordance with the Principles of Reimbursement
			 for Provider Costs under
			 42 U.S.C. §§
										1395
et seq.
as set forth in
			 42 CFR 413,
et seq.
and the
Provider Reimbursement
			 Manual.
(c) Depreciation
			 shall be an allowable cost provided that it is based on historical cost and is
			 calculated by the straight line method. The useful life of assets shall be
			 determined in accordance with the most recent version of the
American
			 Hospital Association's Estimated Useful Lives of Depreciable Hospital
			 Assets.
(d) Costs for
			 leased facilities and fixed equipment shall be an allowable cost to the extent
			 that such costs do not exceed the allowable cost that would have been
			 recognized if the ICF had purchased the equipment or facilities and to the
			 extent that such costs do not exceed rental charges of comparable equipment or
			 facilities.
(e) Costs for equipment
			 and facilities leased under contractual provisions that provide a purchase
			 option at the end of the lease term without more than nominal payment shall not
			 be allowed. Depreciation shall be allowed pursuant to 101 CMR
			 129.04(3)(c).
(f) Interest expense
			 in excess of interest income shall be an allowable cost.
(g) Administrative and general cost in excess
			 of miscellaneous income shall be an allowable cost.
(h) Overhead expenses shall be allocated to
			 non-patient services.
(i) Costs for
			 consultants shall be amortized over the useful life of the asset that
			 consultant work is related to, and the amortized cost shall be an allowable
			 cost.
(j) Payments to professional
			 organizations, trade associations and the like, and comprehensive health
			 planning agencies shall be allowed.
(k) Limitation of basis for depreciation,
			 interest, and equity. Where there has been a change of ownership on or after
			 July 18, 1984, the allowable basis of fixed assets shall be the lower of the
			 acquisition cost or the basis allowed the immediate prior owner reduced by the
			 amount of actual depreciation paid to the prior owner of the facility during
			 all years in which the prior owner participated in the MassHealth
			 program.