New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.21 - Allowable costs

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To be
					 considered as allowable in determining reimbursement rates, costs must be
					 actual, reasonable and properly chargeable to necessary patient care. Except as
					 otherwise provided in this Part, or in accordance with specific determination
					 by the commissioner, allowable costs shall be determined by the application of
					 the principles of reimbursement developed for determining payments under the
					 title XVIII (Medicare) program.
(b)
					 Allowable costs shall not include costs for services that have not been
					 approved by the commissioner.
(c)
					 Allowable costs shall include a monetary value assigned to services provided
					 under contract by religious orders and to services rendered by an owner and
					 operator of a facility or an operator's relatives in accordance with section
					 86-4.27 
					 of this Subpart.
(d) Allowable
					 costs may not include amounts in excess of reasonable or maximum title XVIII
					 (Medicare) costs or in excess of customary charges to the general public. This
					 provision shall not apply to services furnished by public providers free of
					 charge or at a nominal fee. Allowable costs shall not include any amount for
					 bad debts.
(e) Allowable costs
					 shall not include expenses or portions of expenses reported by individual
					 facilities which are determined by the commissioner not to be reasonably
					 related to the efficient production of service because of either the nature or
					 amount of the particular item.
(f)
					 Allowable costs shall not include costs which principally afford diversion,
					 entertainment or amusement to facility owners, operators or
					 employees.
(g) Allowable costs
					 shall not include any interest charged or penalty imposed by governmental
					 agencies or courts, or the costs of policies obtained solely to insure against
					 the imposition of such penalties.
(h) Allowable costs shall not include the
					 direct or indirect costs of advertising (except help-wanted ads), public
					 relations and promotion. Reasonable direct and indirect costs of outreach
					 services designed to attract patients in need of medical services shall be
					 allowable.
(i) Allowable costs
					 shall not include costs or contributions or other payments to political
					 parties, candidates or organizations.
(j) Allowable costs shall include only that
					 portion of the dues paid to any professional association which has been
					 determined by the commissioner to be allocable to expenditures other than for
					 public relations, advertising and political contributions.
(k) Allowable costs shall not include any
					 element of cost determined by the commissioner to have been created by the sale
					 of a facility.
(l) Allowable costs
					 shall include the cost of services incurred by the facility's staff to provide
					 offsite services to registered patients of the facility. Allowable costs shall
					 not include the cost of offsite services provided to nonregistered patients or
					 the cost of services provided through arrangements with other facilities. When
					 the cost of such services cannot be established, income from such services
					 shall be used to adjust allowable costs.
(m) Allowable costs shall include the cost of
					 National Health Service Corps personnel, based upon the liability incurred by
					 the facility for the report period, not actual expenditures for the personnel
					 during the report period.
(n)
					 Allowable costs shall not include the cost of ordered ambulatory services. When
					 the cost of such services cannot be determined, income from the services may be
					 used to adjust allowable costs.
(o)
					 Allowable costs may include certain costs not normally covered under Medicare
					 (title XVIII of the Social Security Act), including but not limited to the cost
					 of dental services, patient transportation, prescription drugs, eyeglasses,
					 prosthetic or orthotic devices, podiatry services.
(p) Allowable costs shall not include the
					 costs of education services, including special classroom programs for preschool
					 and school-age children unable to attend public schools, unless such services
					 are medically necessary.
(q)
					 Allowable costs shall include the costs of recreational services rendered in
					 accordance with a physician's plan of treatment. The costs of recreational
					 services that provide leisure activities shall not be allowable.
(r) Allowable costs shall not include costs
					 related to inpatient services rendered by hospitals or services related to
					 living accommodations in a residential treatment program.
(s) All research costs shall be excluded from
					 allowable costs. Research shall include those studies and projects which have
					 as their purpose the enlargement of general knowledge and understanding, are
					 experimental in nature and hold no prospect of immediate benefit to the
					 facility or its patients.
(t) The
					 costs of educational activities for employees, less tuition paid or reimbursed
					 by other than the facility and supporting tuition or related grants, shall be
					 allowable, provided such activities are directly related to patient care
					 services.