reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › ADMINISTRATIVE SANCTIONS › Section 6210.115 - Failure to adhere to medical evaluation requirements

Current through Register Vol. 54, No. 28, July 13, 2024
If the facility fails to comply with the requirements
						that the physician perform a medical evaluation before admission or before
						authorization for payment, as described under §
											6210.42 (relating to certification
						of initial need for care), which results in a penalty being imposed by the
						United States Department of Health and Human Services on the Department, the
						penalty will be imposed on the facility.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › ADMINISTRATIVE SANCTIONS › Section 6210.116 - Failure to comply with requirements of maintaining recipient's funds

Current through Register Vol. 54, No. 28, July 13, 2024
If discrepancies are identified by audit and the facility
						fails to make restitution to the recipient, the Department may terminate the
						provider agreement for cause.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › RIGHT OF APPEAL › Section 6210.121 - Decisions that may be appealed

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The facility has a right to appeal and
					 have a hearing if dissatisfied with the Department's decision regarding:
(1) The interim per diem rate established by
					 the Department.
(2) The findings of
					 the auditors in the annual audit report.
(3) The determination by the comptroller of
					 the difference between the allowable costs certified by the auditors in the
					 annual audit report, and the total allowance amount as shown on the interim
					 billing.
(4) The denial or
					 nonrenewal of a provider agreement.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › RIGHT OF APPEAL › Section 6210.122 - Additional appeal requirements

Current through Register Vol. 54, No. 28, July 13, 2024
The appeal is subject to the requirements specified in
						§
											1101.84 (relating to provider
						right of appeal).
This section cited in 55 Pa. Code §
													6210.94 (relating to auditing
						  requirements related to recipient fund
						  management).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › RIGHT OF APPEAL › Section 6210.123 - Time limit for submission of appeal

Current through Register Vol. 54, No. 28, July 13, 2024
An appeal shall be taken within 30 days of the date that
						the facility is notified of the decisions specified in §
											6210.121 (relating to decisions
						that may be appealed). Findings contained in a facility's audit report which
						are not appealed by the facility within the 30-day limit will not be considered
						as part of a subsequent appeal proceeding.
This section cited in 55 Pa. Code §
													6210.94 (relating to auditing
						  requirements related to recipient fund
						  management).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › RIGHT OF APPEAL › Section 6210.124 - Submission of appeal

Current through Register Vol. 54, No. 28, July 13, 2024
An appeal shall be mailed to the Director, Office of
						Hearings and Appeals, Department of Human Services, Harrisburg, PA 17120, with
						a copy to the Office of Legal Counsel. The appeal request shall specify the
						issues presented for review.
This section cited in 55 Pa. Code §
													6210.94 (relating to auditing
						  requirements related to recipient fund
						  management).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › RIGHT OF APPEAL › Section 6210.125 - Right to reopen audit

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 The Department may reopen a prior year's audit if an appeal is filed.
(b) For cost reporting periods ending prior
					 to October 1, 1985, if an analysis of the facility's audit report by the Office
					 of the Comptroller discloses that an overpayment has been made to the facility,
					 the facility shall be bound by §
											1101.84(b)(4) and
					 (5) (relating to provider right of
					 appeal).
This section cited in 55 Pa. Code §
													6210.94 (relating to auditing
						  requirements related to recipient fund
						  management).
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 6211.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter specifies the requirements for MA
						reimbursement and allowable costs for non-State operated intermediate care
						facilities for individuals with an intellectual disability.
The provisions of this §
													6211.1 amended under sections
						  201(2), 403.1 and 443.1(2) and (3) of the Human Services Code (62 P.S.
						  §§
														201(2),
						  403.1 and
						  443.1(2) and (3)).
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 6211.2 - Applicability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
					 applies to non-State operated intermediate care facilities for persons with an
					 intellectual disability and non-State operated intermediate care facilities for
					 persons with other related conditions.
(b) The following chapters apply to non-State
					 operated intermediate care facilities for persons with an intellectual
					 disability and non-State operated intermediate care facilities for persons with
					 other related conditions: Chapters 1101 and 6210 (relating to general
					 provisions; and participation requirements for the intermediate care facilities
					 for the intellectual disability program).
(c) In addition to this chapter, the Medicare
					 Provider Reimbursement Manual (HIM-15) applies for costs that are included in
					 this chapter as allowable and for reimbursable costs that are not specifically
					 addressed in this chapter.
(d) If
					 this subchapter is inconsistent with Chapter 6210 or HIM-15, this chapter
					 prevails.
The provisions of this §
													6211.2 amended under sections
						  201(2), 403.1 and 443.1(2) and (3) of the Human Services Code (62 P.S.
						  §§
														201(2),
						  403.1 and
						  443.1(2) and (3)).
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 6211.3 - Legal

Current through Register Vol. 54, No. 28, July 13, 2024
The legal authority for this subchapter is section
						443.1(2) and (3) of the Public Welfare Code (62 P.S. §
												443.1(2) and
						(3)).
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.11 - Basis for standard interim per diem rate

Current through Register Vol. 54, No. 28, July 13, 2024
The standard interim per diem rate for each provider is
						based upon the cost report submitted to the Department by the provider.
The provisions of this §
													6211.11 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).
This section cited in 55 Pa. Code §
													6211.41 (relating to cost
						  reimbursement).
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.12 - Submission of cost report

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 provider shall submit a written report of the costs for the previous Fiscal
					 Year to the Department by September 30 of each year, unless an extension is
					 granted in accordance with procedures in the cost report.
(b) The cost report shall reflect at least 12
					 months of operation.
(c) The cost
					 report shall be submitted on the form prescribed by the Department.
The provisions of this §
													6211.12 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).
This section cited in 55 Pa. Code §
													6211.14 (relating to adjustments
						  to cost report); and 55 Pa. Code §
													6211.41 (relating to cost
						  reimbursement).
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.13 - Review of cost report

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will review the cost report submitted by
						the provider for correctness, consistency with previous audits and cost
						reports, and compliance with the instructions for the cost report.
The provisions of this §
													6211.13 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).
This section cited in 55 Pa. Code §
													6211.41 (relating to cost
						  reimbursement).
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.14 - Adjustments to cost report

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 Department will adjust the cost report based upon the findings of closed audits
					 and cost settlements.
(b) The
					 Department will inform the provider in writing of adjustments to the submitted
					 cost report by January 1 of each year, unless an extension is granted under
					 §
											6211.12(a)
					 (relating to submission of cost report).
(c) If the Department does not inform the
					 provider in writing of adjustments to the submitted cost report by January 1 of
					 each year, the cost report submitted by the provider is accepted by the
					 Department.
The provisions of this §
													6211.14 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).
This section cited in 55 Pa. Code §
													6211.16 (relating to establishment
						  of standard interim per diem rate); and 55 Pa. Code §
													6211.41 (relating to cost
						  reimbursement).
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.15 - Failure to submit cost report

Current through Register Vol. 54, No. 28, July 13, 2024
If the provider does not submit a cost report by
						September 30 of each year, or later if an extension is granted by the
						Department under the procedures of the cost report, the Department will
						establish an interim per diem rate for the provider equal to the lowest interim
						rate for any non-State operated intermediate care facility for persons with an
						intellectual disability issued for the current fiscal year.
The provisions of this §
													6211.15 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).
This section cited in 55 Pa. Code §
													6211.31 (relating to request for
						  waiver); and 55 Pa. Code §
													6211.41 (relating to cost
						  reimbursement).
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.16 - Establishment of standard interim per diem rate

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The standard interim per diem rate shall
					 be used for billing purposes throughout the current fiscal year.
(b) The standard interim per diem rate shall
					 be established by dividing the total projected operating cost by 98% of the
					 maximum possible number of days based on the number of certified beds of the
					 facility.
(c) The total projected
					 operating cost is derived under the following procedures:
(1) Taking the total MA allowable costs,
					 including adjustments for income, and comparing this to the approved budget
					 total, or the total projected operating costs if applicable, for the same
					 fiscal year in order to determine the lesser amount. From the lesser amount,
					 subtract depreciation on capital assets, limited to buildings and fixed
					 equipment, and interest on capital indebtedness.
(2) The Department may apply a cost of living
					 adjustment to the interim per diem rate during the rate development
					 process.
(3) Adding depreciation on
					 capital assets, limited to buildings and fixed equipment, and interest on
					 capital indebtedness to the total projected cost to result in the total
					 projected operating cost.
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.17 - Efficiency incentive

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An
					 efficiency incentive is allowable if the facility's actual allowable costs are
					 less than the total projected operating costs, audit exceptions total no more
					 than 6% of the facility's total projected operating costs, and if the standard
					 interim per diem rate was used in the previous fiscal year. If the standard
					 interim per diem rate was not used in the previous fiscal year, no efficiency
					 incentive is allowed.
(b)
					 Efficiency incentives shall be based upon actual audited allowable costs.
					 Efficiency incentives shall be equal to 50% of the difference between actual
					 and total projected operating costs up to a maximum of 6% of the total actual
					 audited costs for the facility for the fiscal year.
(c) The Department will not require that the
					 efficiency incentive to be used to offset allowable costs.
This section cited in 55 Pa. Code §
													6211.41 (relating to cost
						  reimbursement).
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 › STANDARD INTERIM PER DIEM RATE › Section 6211.18 - Upper limits of payment if the standard interim per diem rate is used

Current through Register Vol. 54, No. 28, July 13, 2024
If the standard interim per diem rate is used, the
						provider shall operate within the total projected operating cost as defined in
						§
											6211.16(c)
						(relating to establishment of standard interim per diem rate). Actual,
						allowable and reasonable costs shall be determined at the time of audit, in
						accordance with this subchapter and HIM-15. Total reimbursement is limited to
						the sum of verified actual, allowable costs plus the efficiency incentive
						payment, if applicable, or the total projected operating cost, whichever is
						lower.
This section cited in 55 Pa. Code §
													6211.41 (relating to cost
						  reimbursement).
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 › WAIVER OF STANDARD INTERIM PER DIEM RATE › Section 6211.31 - Request for waiver

Current through Register Vol. 54, No. 28, July 13, 2024
(a) To
					 request additional funds for the fiscal year, the provider shall submit a
					 request for a waiver of the standard interim per diem rate in accordance with
					 the requirements of this section. A request can only be submitted if one or
					 more of the following conditions exist:
(1)
					 The facility has been certified as an ICF/ID for less than 18 months prior to
					 the closing date of the most recently submitted cost report.
(2) There has been an increase or decrease in
					 the certified capacity of a facility during the current fiscal year.
(3) An increase or decrease in the certified
					 capacity is anticipated for the next fiscal year.
(4) The characteristics of a client have
					 changed significantly causing significant program changes, resulting in
					 demonstrably different costs.
(5)
					 An unforeseen circumstance has resulted in demonstrably different
					 costs.
(6) The facility has changed
					 ownership.
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 › WAIVER OF STANDARD INTERIM PER DIEM RATE › Section 6211.32 - Approved waiver

Current through Register Vol. 54, No. 28, July 13, 2024
(a) After
					 the Department has notified the provider that a waiver has been granted, the
					 Department will establish the total approved revised budget level.
(b) If a waiver is granted, the Department
					 will establish budget levels by major object of expenditure and cost center.
					 The budget level will be based on this chapter and HIM-15.
(c) If a waiver is granted, the Department
					 will establish an interim per diem rate by dividing the total approved budget
					 level minus offsetting income, by 98% of the maximum potential certified
					 occupancy or the occupancy percentage requested by the provider in the budget,
					 whichever is higher.
(d) If a
					 waiver is granted, the interim per diem rate shall be used for billing purposes
					 throughout the fiscal year.
The provisions of this §
													6211.32 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).
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 › WAIVER OF STANDARD INTERIM PER DIEM RATE › Section 6211.33 - Denied waiver

Current through Register Vol. 54, No. 28, July 13, 2024
(a) After
					 the Department has notified the provider that a waiver has been denied, the
					 provider shall use the standard interim per diem rate, as specified in §
											6211.15 (relating to establishment
					 of standard per diem rate).
(b) If
					 a waiver is denied, the provider may appeal the denial within 30 calendar days
					 of the mailing date of the Department's notice of the waiver denial.
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 › WAIVER OF STANDARD INTERIM PER DIEM RATE › Section 6211.34 - Upper limits of payment if a waiver is granted

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a waiver is granted and the budget is
					 used to establish the interim per diem rate, the provider shall operate within
					 10% of the approved budget levels for major object of expenditure and cost
					 center as defined in §
											6211.123 (relating to major
					 objects of expenditure and cost centers within the budget).
(b) Actual, allowable, and reasonable costs
					 shall be determined at the time of the audit in accordance with this
					 subchapter. Total reimbursement is limited to the sum of audited actual
					 allowable costs or the total approved budget level, whichever is
					 lower.
(c) An efficiency incentive
					 is not available if a waiver of the standard interim per diem rate is
					 granted.
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 › REIMBURSEMENT › Section 6211.41 - Cost reimbursement

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Subject to the limitations specified in §§
											6211.11-6211.18 (relating to standard
					 interim per diem rate), the facility will be reimbursed allowable operating
					 costs, including allowable depreciation and interest on capital indebtedness,
					 up to the established total projected operating cost. If a waiver is granted
					 and a budget is used to establish the interim per diem rate, the facility will
					 be reimbursed for allowable costs up to the limits of an approved
					 budget.
(b) The amount of
					 reimbursement for allowable operating costs, including depreciation and
					 interest, may not exceed the level of operating costs the Department determines
					 to be reasonable and adequate to meet the costs that an efficiently and
					 economically operated facility incurs in meeting applicable State and Federal
					 law and quality and safety standards.
(c) Costs that are not recognized as
					 allowable costs in a fiscal year shall not be carried forward or backward to
					 other fiscal years for inclusion in allowable costs.
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 › REIMBURSEMENT › Section 6211.42 - Allowable costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A facility's
					 direct or indirect allowable costs related to client care are considered in the
					 finding and allocation of costs to the MA Program for its eligible
					 recipients.
(b) Total allowable
					 costs of a facility shall be apportioned between third-party payors and other
					 clients so that, within the limits of this subchapter, the share borne by MA
					 under Title XIX of the Social Security Act (42 U.S.C.A. §§
												1396-1396p) is based upon those actual
					 services and costs related to MA clients. Allowable costs shall be apportioned
					 by multiplying the interim per diem cost by the number of eligible client days
					 for MA clients.
(c) The provider is
					 responsible for the accounting of all costs and services. All miscellaneous
					 costs shall be documented and justified to the Department. Allowable costs do
					 not include charity, in-kind and courtesy allowances.
(d) If, under MA principles, there is more
					 than one method for handling a cost item, the method initially elected by the
					 provider shall be followed consistently in subsequent reporting periods, unless
					 there is prior written justification and approval from the Department for using
					 a different method.
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 › REIMBURSEMENT › Section 6211.43 - Cost reporting

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 facility shall identify, for cost finding, allowable direct, indirect,
					 ancillary, and related organization costs that apply to client care.
(b) The facility shall submit a cost report,
					 to the Department in accordance with Departmental requirements. The cost report
					 must be based on financial and statistical records maintained by the facility.
					 The cost information contained in the cost report must be current, accurate,
					 and in sufficient detail to support the claim for reimbursement. If any of the
					 cost report instructions are inconsistent with the subchapter, the provisions
					 of this subchapter shall apply.
(c)
					 A cost report must be submitted to include any costs in a fiscal
					 year.
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 › REIMBURSEMENT › Section 6211.44 - Financial records

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 facility shall maintain adequate financial and statistical records and for
					 determination of costs payable under the MA Program.
(b) The facility shall maintain at least all
					 of the following records:
(1) General
					 financial ledgers, journals, and books.
(2) Original evidence of cost, such as
					 purchase requisitions, purchase orders, vouchers, vendor invoices, requisitions
					 for supplies, inventories, time cards, payrolls and bases for apportioning
					 costs, that relate to the determination of reasonable costs and that are
					 auditable.
(3) Allocated
					 administrative costs.
(4) Records
					 relating to each cost report for the past 4 years a cost report was submitted
					 to the Department.
(5) Cash
					 disbursement journal.
(6) Cash
					 receipts journal.
(7) Payroll
					 journal or computer printout.
(8)
					 Fixed asset ledger or equivalent.
(9) Inventory control record.
(10) Chart of accounts that parallels or
					 cross-walks to the budget format issued by the Department.
(11) Statement listing all sources of revenue
					 to the facility, including Federal, State, local, and private
					 sources.
(12) Accounting records
					 for the past 4 years.
(13)
					 Documentation of employe compensation, by facility positions and functionally
					 equivalent Commonwealth positions.
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 › REIMBURSEMENT › Section 6211.45 - Disclosure

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If costs have
					 been allocated between programs and supporting services, disclosure shall be
					 made in accordance with generally accepted accounting principles.
(b) If the facility is a controlling
					 organization, disclosure of the affiliate existence and its relationship to the
					 established intermediate care facility for individuals with an intellectual
					 disability shall be made, including the nature of any financial transaction
					 between the affiliate and the facility.
The provisions of this §
													6211.45 amended under sections
						  201(2) and 443.1(2) and (3) of the Human Services Code (62 P.S.
						  §§
														201(2) and
						  443.1(2) and
						  (3)).
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 › REIMBURSEMENT › Section 6211.46 - Financial statement

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Agencies operating facilities in different locations with a consolidated
					 financial report shall designate cost centers for each location in the
					 statement of financial activities. In addition, information accompanying the
					 financial statement shall include the basis used in allocating income and
					 expenses to each location.
(b)
					 Financial statements are subject to field audits by the auditing staff from the
					 Department or other responsible State and Federal auditing units.
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 › REIMBURSEMENT › Section 6211.47 - Operation of multiple program types

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a provider operates intermediate care
					 facilities for persons with an intellectual disability as well as other types
					 of programs, the provider shall document at the time of audit, or if a waiver
					 is requested the provider shall submit with the budget a detailed account of
					 how various costs are allocated between the multiple programs, under §
											6211.72 (relating to
					 administrative costs).
(b) The
					 detailed account of the allocation shall include at least all of the following:
(1) All salary costs for individuals
					 responsible for more than one program.
(2) Employee fringe benefits for individuals
					 responsible for more than one program.
(3) All rental costs that apply to multiple
					 programs.
(4) All motor vehicles
					 that are used by multiple programs.
(5) All other related expenses shared by
					 multiple programs.
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 › REIMBURSEMENT › Section 6211.48 - Changing the basis for allocating cost centers

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a provider wants to use an allocation
					 basis for a particular cost center that is different from that required by the
					 cost report, the provider shall submit a written request and justification for
					 the change to the Department. The written request and justification shall be
					 submitted prior to the beginning of the cost reporting period for which the
					 change is to apply.
(b) The
					 Department will approve or deny the provider's request for change of the
					 allocation basis in writing. If the Department approves the provider's request,
					 the change must be applied to the cost reporting period for which the request
					 was made, and to all subsequent cost reporting periods, unless the Department
					 approves a subsequent request for change by the provider.
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 › BED OCCUPANCY › Section 6211.61 - Minimum occupancy rate

Current through Register Vol. 54, No. 28, July 13, 2024
A facility shall maintain a minimum average annual rate
						of occupancy of 98% of its available certified bed capacity.
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 › BED OCCUPANCY › Section 6211.62 - Computing the minimum occupancy rate

Current through Register Vol. 54, No. 28, July 13, 2024
The average annual rate of occupancy is computed by
						dividing the total actual days provided by the total certified bed days
						available during the fiscal period. The total actual days provided include all
						days of service actually provided plus reserve bed days including therapeutic
						leave and medical leave days in full up to the limits allowed by §
											1181.56 (relating to limitations
						on payment for reserved beds). Reserved beds counted as actual days of service
						shall not be filled.
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 › BED OCCUPANCY › Section 6211.63 - Occupancy level adjustment

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An occupancy level adjustment to
					 reimbursements for fixed costs will be made for facilities with less than 98%
					 occupancy in the absence of an approved waiver under §
											6211.64 (relating to waiver of
					 minimum occupancy rate).
(b) The
					 occupancy level adjustment will be computed by subtracting the average annual
					 rate of occupancy from 98% of the available certified bed occupancy. Fixed
					 costs will be reduced by the resulting percentage. Fixed costs include the cost
					 of general administration, rent, utilities, communications, other interest,
					 insurance, real estate taxes and depreciation and interest on capital
					 indebtedness. Fixed costs do not include variable costs such as staffing and
					 food.
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 › BED OCCUPANCY › Section 6211.64 - Waiver of minimum occupancy rate

Current through Register Vol. 54, No. 28, July 13, 2024
A provider may request a waiver of the minimum occupancy
						requirement at the time that a final cost report is submitted to the
						Department. The request for waiver of the minimum occupancy requirement shall
						be submitted in writing to the Deputy Secretary for Office of Developmental
						Programs. Documentation shall be submitted related to one or more of the
						following conditions:
(1) The facility
					 is in its first year of operation.
(2) The facility is increasing or decreasing
					 the number of certified beds.
(3)
					 The facility operates less than 16 beds.
The provisions of this §
													6211.64 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).
This section cited in 55 Pa. Code §
													6211.63 (relating to occupancy
						  level adjustment).
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 › ALLOWABLE COSTS › Section 6211.71 - Determination of allowable costs

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will determine allowable costs in
						accordance with the following:
(1) The
					 requirements of this subchapter.
(2) The limits of the provider's total
					 projected operating cost, or if a waiver is granted, the limits of an approved
					 budget.
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 › ALLOWABLE COSTS › Section 6211.72 - Administrative costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Administrative costs include costs incurred for a common or joint purpose and
					 are associated with supportive activities that are necessary to maintain the
					 direct effort involved in providing the program services.
(b) Administrative costs shall be apportioned
					 as general administration or allocated to other cost centers.
(c) Allowable administrative costs include:
(1) Compensation of the facility's
					 administrator, controller, purchasing agent, personnel director, and other
					 persons performing general supervision or management duties.
(2) Costs associated with the provision of
					 supporting services such as bookkeeping, data processing, and
					 auditing.
(3) Costs of space used
					 for administrative purposes, including depreciation and interest or
					 rental.
(4) Purchase of supplies
					 and equipment used for administrative purposes.
(5) Operating costs associated with
					 administrative purposes, such as travel and communications.
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 › ALLOWABLE COSTS › Section 6211.73 - Compensation and staffing costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Compensation for direct care,
					 administrative, and support staff are allowable costs. Compensation is
					 allowable up to the combined prevailing Commonwealth salaries and benefits for
					 functionally equivalent positions.
(b) Payment will not be made to exceed an
					 overall ratio of one direct care staff to one certified bed, unless
					 documentation supports the need to exceed the ratio to establish and maintain
					 certification. The overall ratio shall be calculated based upon the average
					 fulltime equivalent direct care staff for the fiscal year and the average
					 number of certified beds for this period. Staff are counted in the overall
					 ratio for the percentage of time they are assigned to the facility in
					 performing a direct care function.
(c) Various personnel costs that are not
					 provided through salaried complement for the provision of necessary services
					 for individual clients are allowable. Contracts that specify the nature of the
					 service and define the unit and cost of the service shall be maintained by the
					 facility, in addition to documentation of services rendered.
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 › ALLOWABLE COSTS › Section 6211.74 - Service contracts

Current through Register Vol. 54, No. 28, July 13, 2024
Costs necessary for the operation of the facility and the
						establishment and maintenance of intermediate care facilities for persons with
						an intellectual disability certification are allowable to the extent that the
						costs do not duplicate services performed by staff on complement. Service
						contracts shall specify the nature and cost of the service. Documentation of
						service contracts shall be maintained by the facility with all documentation of
						services rendered.
The provisions of this §
													6211.74 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).
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 › ALLOWABLE COSTS › Section 6211.75 - Unit of service contracts

Current through Register Vol. 54, No. 28, July 13, 2024
Costs associated with unit of service contracts are
						allowable if the following conditions apply:
(1) Units of service for which costs are
					 claimed have been delivered.
(2)
					 The unit of service arrangement is more economical and efficient than other
					 contractual relationships.
(3)
					 Services do not duplicate those provided by staff on complement.
(4) The service is not otherwise available
					 and accessible through the Medical Assistance Program.
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 › ALLOWABLE COSTS › Section 6211.76 - Day habilitation costs

Current through Register Vol. 54, No. 28, July 13, 2024
Costs associated with day programs providing habilitative
						services as required by the clients' individual program plans, will be
						reimbursed subject to other applicable requirements of this
						subchapter.
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 › ALLOWABLE COSTS › Section 6211.77 - Cost of drug services

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Detailed and itemized documentation of the claimed expense must be maintained
					 in order for drug services to be allowable.
(b) Drug services costs are allowable for
					 nonlegend drugs such as laxatives, aspirin, and antacids if the drugs are
					 provided directly to the resident from the facility's own drug
					 supply.
(c) The provision of
					 nonlegend drugs by a facility to its medical assistance clients shall be based
					 on a physician's written order or prescription, be administered judiciously,
					 and be limited to those that are medically necessary for the client.
(d) Costs related to legend drugs for which
					 payment will be made under the MA Program to an enrolled pharmacy or costs
					 related to legend drugs that are noncompensible under the MA Program are not
					 considered as allowable costs for a facility. The Department will directly
					 reimburse licensed pharmacies for compensable prescribed drugs furnished to
					 eligible medical assistance clients.
(e) Medically needy residents are not
					 eligible to receive prescription drugs under the MA Program. If the facility
					 acts as an agent for residents in purchasing drugs, the facility shall act as a
					 prudent buyer.
(f) The facility
					 shall not solicit or receive any remuneration directly or indirectly in cash or
					 in kind from a person in connection with the furnishing of drugs or in
					 connection with referring a recipient to a person for the furnishing of
					 drugs.
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 › ALLOWABLE COSTS › Section 6211.78 - Staff development and training costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Costs associated with staff development
					 and training costs are allowable if the training and development is associated
					 with the individual program goals and objectives of the intermediate care
					 facilities for the intellectual disability program.
(b) Staff development and training costs are
					 allowable in accordance with intermediate care facilities for individuals with
					 an intellectual disability certification requirements.
The provisions of this §
													6211.78 amended under sections
						  201(2), and 443.1(2) and (3) of the Human Services Code (62 P.S.
						  §§
														201(2), and
						  443.1(2) and
						  (3)).