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 86-2 - Residential Health Care Facilities › Section 86-2.17 - Allowable costs

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To be
					 considered as allowable in determining reimbursement rates, costs shall be
					 properly chargeable to necessary patient care. Except as otherwise provided in
					 this Subpart, 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 title XVIII of the
					 Federal Social Security Act (Medicare) program.
(b) Allowable cost shall include a monetary
					 value assigned to services provided by religious orders and for services
					 rendered by an owner and operator of a residential health care
					 facility.
(c) Allowable costs may
					 not include amounts in excess of reasonable or maximum title XVIII of the
					 Federal Social Security Act (Medicare) costs or in excess of customary charges
					 to the general public. For purposes of this determination, customary charges to
					 the general public shall equal an average of the applicable charges weighted by
					 patient days. This provision shall not apply to services furnished by public
					 providers free of charge or at a nominal fee.
(d) Allowable costs shall not include
					 expenses or portions of expenses reported by individual residential health care
					 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.
(e)
					 Any general ceilings applied by the commissioner, as to allowable costs in the
					 computation of reimbursement rates, shall be published in a hospital memorandum
					 or other appropriate manner.
(f)
					 Allowable costs shall not include costs not properly related to patient care or
					 treatment which principally afford diversion, entertainment or amusement to
					 owners, operators or employees of residential health care facilities.
(g) Allowable costs shall not include any
					 interest charged related to rate determination or penalty imposed by
					 governmental agencies or courts, and the costs of policies obtained solely to
					 insure against the imposition of such a penalty.
(h) Allowable costs shall not include the
					 direct or indirect costs of advertising, public relations or promotion except
					 in those instances where the advertising is specifically related to the
					 operation of the residential health care facility and not for the purpose of
					 attracting patients.
(i) Allowable
					 costs shall not include costs of 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
					 demonstrated, to the satisfaction of the commissioner, to be allocable to
					 expenditures other than for public relations, advertising or political
					 contributions. Any such costs shall also be subject to any cost ceilings that
					 may be promulgated by the commissioner.
(k) Allowable costs shall not include any
					 element of cost as determined by the commissioner to have been created by the
					 sale of a residential health care facility.
(l) Allowable costs shall not include the
					 interest paid to a lender related through control, ownership, affiliation or
					 personal relationship to the borrower, except in instances where the prior
					 approval of the Commissioner of Health has been obtained.
(m) Allowable costs shall be reduced by
					 income earned for Medicare part B eligible services to the extent that Medicaid
					 has paid for these services.
(n)
					 Allowable costs shall include any fee assessed by the commissioner on a
					 residential health care facility, for the purpose of providing revenue for the
					 account established pursuant to chapter 1021 of the Laws of 1981. The
					 reimbursement rate for a facility shall reflect the cost of the annual fee
					 prior to collection of the fee through the rate of reimbursement.