Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6211 - ALLOWABLE COST REIMBURSEMENT FOR NON-STATE OPERATED INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY › GENERAL PROVISIONS › Section 6211.4 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
						have the following meanings, unless the context clearly indicates
						otherwise:
Allocate
-To designate a specific task,
						service or supply to a specific cost center because of its direct relationship
						to client care and identifiable measure of application.
Allowable cost
-The cost reimbursed under
						MA, that is the facility's actual audited allowable cost after appropriate
						adjustments are certified by Commonwealth auditors.
Apportion
-To divide costs that are
						necessary to program operation but that cannot be directly or entirely charged
						to a specific cost center.
Arms-length transaction
-A transaction
						including independent unrelated parties (no interest such as equity, control,
						contracts, interlocking directorates, officers, and the like); and, a willing
						buyer and a willing seller.
Assets
-Economic resources that are owned
						by a business and are expected to benefit future operations.
Budget
-A plan of financial operation for
						some future period expressed in monetary terms.
Capital asset
-An item with a useful life
						of more than 1 year or that would not meet Internal Revenue Service standards
						for nondepreciable assets. The term includes buildings, renovations and
						building improvements, and moveable items such as furniture and fixtures,
						computers and transportation equipment. Land is not a depreciable capital
						asset.
Change of ownership
-The sale or transfer
						of a facility and all of its assets to another person, corporation,
						organization or partnership, with the expectation that the facility will
						continue to operate for the same purpose for which it is currently being
						used.
Closed audit
-An audit is closed when the
						written audit report has been distributed and one of the following
						occurs:
(i) The period for appeal has
					 passed.
(ii) An appeal has been
					 concluded and finalized. The closed audit results in final settlement, which is
					 either additional payments due to the provider or a repayment of funds
					 dispersed to the provider for disallowed costs.
Compensation
-The total remuneration paid
						to an individual employe, including wages or salaries and benefits.
Competitive bidding process
-The method
						used to procure goods or services by obtaining three or more vendor cost
						proposals and selecting the proposal with the lowest responsible bid.
Cost center
-A group of services or
						employes, or both, or another unit or type of activity into which functions of
						a facility are divided for purposes of expense assignment and
						allocations.
Cost report
-A summary of client
						occupancy, income and expenses for a given period, presented in a manner
						prescribed by the Department.
Cost settlement
-A retroactive adjustment
						based on a cost report, made at the end of a reporting period, to bring the
						interim payments made to the provider during that reporting period into
						agreement with the reimbursable amount payable to the provider for the
						allowable services actually rendered to program beneficiaries during that
						period. Final adjustment is made after an audit is closed.
Current fiscal year
-The fiscal year in
						which the interim per diem rate is to be used.
Depreciable assets
-Equipment, buildings
						and fixtures that have a purchase price of more than $500 and are expected to
						have a useful life of more than 1 year.
Depreciation
-Apportionment of the value
						of an asset over its useful life.
Direct care staff
-Staff assigned to
						perform direct responsibilities related to activities of daily living,
						self-help and socialization skills. Staff involved in regularly scheduled
						specialized developmental programs with clients are not included in direct care
						staff. Professional staff may be included in direct care staff.
Efficiency incentive
-A remuneration to a
						provider that may be earned by spending less than projected operating expenses
						within specified guidelines.
Facility
-A non-State operated
						intermediate care facility for persons with an intellectual disability or a
						non-State operated intermediate care facility for persons with other related
						conditions.
Fair market rental appraisal
-The
						determination of reasonable payment to a lessor for a rented space by a
						qualified real estate appraiser.
Interest
-The direct cost incurred for
						the use of borrowed funds.
Interest on capital indebtedness
-The
						direct cost incurred for funds borrowed for capital purposes. Examples of
						interest on capital indebtedness include acquisition of facilities, equipment
						and capital improvements. Generally, loans for capital purposes are long term
						loans.
Interest on current indebtedness
-The
						direct cost incurred for funds borrowed for a relatively short term, usually
						for purposes such as working capital for normal operating expenses.
Investment income
-Return on funds not
						expended by the facility and placed with a third party. The term includes
						interest income from bonds and savings accounts, premiums and dividends on
						stock purchases, and income from trust agreements.
Major object of expenditure
-A generic
						classification of costs within cost centers including personnel, equipment,
						operating costs, depreciation and interest, and apportioned costs.
Management fee
-A charge for general
						administrative services incurred for a common or joint purpose not readily
						assignable to a specific cost center.
Practitioner
-Salaried or contracted
						practitioners including physicians, dentists, podiatrists, occupational
						therapists and physical therapists.
Prudent buyer
-A term for the price paid
						for items by a cost-conscious purchaser in the open market under competitive
						conditions.
Reasonable costs
-Necessary and proper
						costs incurred by the provider, based on the expectation that the facility is
						operated efficiently and economically.
Related party
-An organization related to
						the provider by common ownership or control. Related to the provider means that
						the provider, to a significant extent, is associated with, affiliated with or
						has control of or is controlled by the organization furnishing the services.
						Common ownership exists when an individual possesses significant ownership or
						equity in the provider and the institution or organization serving the
						provider. Control exists where an individual or an organization has the power,
						directly or indirectly, to significantly influence or direct the actions or
						policies of an organization or institution.
Request for proposal
-A formal document
						describing services requested that is provided to interested contractors along
						with information to enable the preparation and submission of proposals for
						evaluation and selection.
Service contract
-An obligation between a
						provider and supplier in which the nature and cost of service is specified, and
						reimbursement is not based upon actual units of service provided.
Standard interim per diem rate
-The rate
						established by the Department in accordance with §
											6211.16 (relating to establishment
						of standard interim per diem rate) for the purpose of making interim payments
						to the facility pending a year-end cost settlement.
Start-up costs
-Costs incurred by the
						provider in developing its ability to furnish client care services prior to
						certification of the facility or admission of the first client.
Unit of service contract
-An obligation
						between a provider and supplier in which the unit is defined, a price for the
						unit is stipulated, the basis for the price and unit is justified, and
						reimbursement is based upon actual units of service provided.
The provisions of this §
													6211.4 amended under sections
						  201(2), 403(b) and 403.1 of the Human Services Code (62 P.S. §§
														201(2),
						  403(b) and
						  403.1).