reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › REIMBURSEMENT PRINCIPLES › Section 1181.215 - Efficiency incentive

Current through Register Vol. 54, No. 28, July 13, 2024
Subject to the sanctions specified in §§
											1181.91-1181.96 (relating to
						administrative sanctions), an efficiency incentive will be allowable for a
						nonpublic facility if the facility's audited net operating per diem costs are
						less than the applicable group ceiling. In determining the efficiency
						incentive, the following limitations apply:
(1) Proprietary facilities may receive an
					 efficiency incentive of up to 8.5% of the Statewide average net operating per
					 diem cost of general nursing facilities excluding hospital-based and special
					 rehabilitation facilities for each level of care for the prior fiscal
					 year.
(2) Nonprofit facilities may
					 receive an efficiency incentive of up to 6% of the Statewide average net
					 operating per diem cost of general nursing facilities excluding hospital-based
					 and special rehabilitation facilities for each level of care for the prior
					 fiscal year.
(3) In no event may
					 the total of a facility's audited net operating per diem rate and the
					 efficiency incentive exceed the applicable group ceiling for the
					 facility.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › REIMBURSEMENT PRINCIPLES › Section 1181.216 - Depreciation and interest reimbursement

Current through Register Vol. 54, No. 28, July 13, 2024
Except as provided otherwise in §§
											1181.91-1181.96 (relating to
						administrative sanctions) and in this subchapter allowable depreciation and
						interest on capital indebtedness, within the limitations specified in this
						subchapter, will be recognized as separate cost items and will be excluded from
						the limitation of the applicable ceiling on net operating
						costs.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › REIMBURSEMENT PRINCIPLES › Section 1181.217 - Establishing ceilings for allowable net operating costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Department will establish annual
					 ceilings on allowable net operating costs for each level of care.
(b) For ceiling setting purposes, the
					 following apply:
(1) Certain facilities will
					 be grouped together as follows:
(i)
					 Hospital-based skilled nursing and intermediate care facilities and special
					 rehabilitation facilities separately on a Statewide basis.
(ii) General skilled nursing and intermediate
					 care facilities according to Metropolitan Statistical Areas (MSA) groups. For
					 general skilled nursing and intermediate care facilities the MSA
					 classifications will be grouped, based along geographic and economic lines,
					 into levels as announced by the Federal Office of Management and Budget. For
					 county facilities, Level A will be combined with Level B and Level C will be
					 combined with the non-MSA level. The resulting two levels will be the county
					 nursing facility groups for ceiling setting purposes.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › RATE DETERMINATIONS › Section 1181.221 - Determining the interim per diem rate

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An interim per diem rate will be
					 established based on the facility's most recently filed cost report as adjusted
					 for nonallowable costs by desk review. The cost report shall cover at least a
					 180 day period in order to qualify as a basis for interim per diem rate
					 setting.
(b) Interim per diem rates
					 will remain in effect for no less than 6 months.
(c) Interim per diem rates will be
					 established under §
											1181.68 (relating to upper limits
					 of payment).
This section cited in 55 Pa. Code §
													1181.101 (relating to facility's
						  right to a hearing).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › RATE DETERMINATIONS › Section 1181.222 - Determining a cost-related prospective rate for certain facilities

Current through Register Vol. 54, No. 28, July 13, 2024
(a) As an
					 alternative to having a current interim per diem rate that is subject to annual
					 adjustment to allowable costs under this subchapter, an in-State facility with
					 a monthly average of ten Medical Assistance patients or less may request that
					 the Department determine a prospective per diem rate for the facility. County
					 and hospital-based nursing facilities, special rehabilitation facilities and
					 intermediate care facilities for the mentally retarded may not elect to have a
					 prospective rate.
(b) The
					 prospective rate shall be determined prior to the beginning of the Department's
					 fiscal year and will be based on the facility's projected MA-11 cost report,
					 historical financial statements, and other third-party payor audit reports. The
					 established per diem rate will be effective July 1 and will remain in effect
					 through June 30 of the current fiscal year.
(c) Payments made under a prospective rate
					 may not be subject to annual cost reporting by the facility or to year-end
					 adjustment by the Medical Assistance Program. However, facilities with a
					 prospective rate which render more than 3,650 Medical Assistance patient days
					 may not meet the conditions specified in subsection (a) and will be required to
					 submit a year-end cost report and will be subject to an audit and year-end
					 adjustment by the Department.
(d)
					 The prospective rate, excluding depreciation and interest, may not exceed the
					 applicable group ceiling for the facility. The prospective rate, including
					 depreciation and interest, may not exceed the facility's private payor rate or
					 the facility's Medicare interim rate.
(e) Facilities that request a prospective
					 rate will not be eligible to receive an efficiency incentive.
(f) The costs of facilities with prospective
					 rates will not be included in the costs used to establish ceilings.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › RATE DETERMINATIONS › Section 1181.223 - Determining the interim per diem rate for a new facility or a facility with a change of ownership

Current through Register Vol. 54, No. 28, July 13, 2024
For existing or newly constructed facilities that are
						entering the Medical Assistance Program and for facilities in the Program that
						have undergone a change of ownership, the facility's MA-11 projected cost
						report and all other required information as specified in this part will be
						used to set the interim rate for Medical Assistance during the initial period
						of operation, pending the filing of the first year-end cost
						report.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › RATE DETERMINATIONS › Section 1181.224 - Final per diem rate

Current through Register Vol. 54, No. 28, July 13, 2024
The final per diem rate may not exceed the upper limits
						of payment specified in §
											1181.68 (relating to upper limits
						of payment) and is subject to the sanctions in §§
											1181.91-1181.96 (relating to
						administrative sanctions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › ALLOWABLE COSTS › Section 1181.231 - Standards for general and selected costs

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will determine providers' allowable costs
						in accordance with all of the following:
(1) Chapter 1101 (relating to general
					 provisions), Subchapter A (relating to nursing facility care), and this
					 subchapter.
(2) The Medicare
					 Provider Reimbursement Manual (HIM-15), except that where this part and the
					 HIM-15 differ with respect to the treatment of a cost allowable in both, this
					 part will govern.
(3) Section
					 1181.68 (relating to upper limits
					 of payment).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › ALLOWABLE COSTS › Section 1181.232 - Changing the basis for allocating cost centers

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Occasionally a provider may wish to use
					 an allocation basis for a particular cost center which is different than that
					 required by the MA-11 because the provider believes the change will result in
					 more appropriate and more accurate allocation. In these cases the provider
					 shall submit a written request to the Department for approval of the change and
					 provide reasonable justification for the change prior to the beginning of the
					 cost reporting period for which the change is to apply.
(b) The Department's approval or denial of a
					 provider's request will be furnished to the provider in writing. If the
					 Department approves the provider's request, the change shall 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. If the request is denied, the facility shall continue
					 to use the most current of either the allocation basis established by the
					 Department or the facility's most current revised allocation basis that was
					 approved by the Department. The acknowledgement by the Department's auditors
					 that a particular cost-allocation methodology exists may neither be construed
					 as nor used as a substitute for written Departmental approval of the facility's
					 request for a change in the basis for allocating costs.
(c) The effective date of an approved request
					 for a change in the allocation basis will be the beginning of the
					 cost-reporting period for which the request was made.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › ALLOWABLE COSTS › Section 1181.232a - Bed changes during a cost reporting period-statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Interim
					 rate level
. The Department will accept the required or previously
					 approved allocation bases and use the bed complement on the final day of the
					 reported period as the basis for setting the interim rate. Allocation bases
					 accepted at interim rate will be subject to verification at audit.
(b)
Audit level
. The
					 provider is required by regulation to keep adequate documentation of the cost
					 by the level of care.
(1) For cost reporting
					 periods ending before June 30, 1988, the provider may use multiple Schedule C's
					 or actual statistics. The preferred method for documenting this is to submit
					 supplemental Schedule C's which identify costs being allocated by proper
					 statistics for each period of change. These supplemental Schedule C's will then
					 be combined on a summary Schedule C which would become the required Schedule C
					 to be included in the MA-11 Cost Report. The supplemental Schedule C's should
					 be submitted with the MA-11 Cost Report. For periods ending after June 30,
					 1988, the provider shall use multiple Schedule C's.
(2) For either time period, the absence of
					 required documentation will result in zero cost. The absence of required
					 documentation or the use of other methods which do not properly reflect use of
					 the Department's required allocation bases or approved change in bases will
					 result in zero cost being allowed for that line item.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › ALLOWABLE COSTS › Section 1181.233 - Bed occupancy allowance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 facility shall maintain an average annual rate of occupancy of a minimum of 90%
					 of its available bed capacity on a facility-wide basis.
(b) For a facility with less than 90%
					 occupancy facility-wide, the number of total patient days shall be adjusted so
					 that the 90% factor can be achieved. If occupancy for each level of care is
					 below 90%, the patient days for each shall be adjusted to bring each to the 90%
					 level.
(c) The occupancy level
					 adjustment will be applicable to fixed costs such as depreciation, rent,
					 interest, insurance and taxes. It will not apply to variable costs, such as
					 staffing and food, since these costs should decrease as the occupancy level
					 decreases.
(d) The average per diem
					 rate determined at the end of the facility's fiscal year will be calculated in
					 accordance with this section.
(e) A
					 bed reserved for a recipient who is hospitalized will not be counted as an
					 occupied bed unless the reserved bed is filled with another patient while the
					 Medical Assistance recipient is hospitalized. A bed reserved for a recipient
					 who is on therapeutic leave will be counted as an occupied bed.
(f) A waiver to the minimum bed occupancy
					 allowance will be made for a new facility, at the time of the audit, relating
					 to the facility's first 12 months of operation. If the facility has been in
					 operation for at least 12 months prior to coming into the Medical Assistance
					 Program, this waiver does not apply. This subsection does not apply to new
					 additions to existing facilities or to the replacement of existing
					 facilities.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › ALLOWABLE COSTS › Section 1181.234 - General administration allowance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The allowable cost of general
					 administration will be limited. The allowable cost of general administration
					 for each level of care will be determined so that all other allowable costs,
					 excluding depreciation and interest on capital indebtedness, equal no less than
					 88% of the allowable net operating costs, except as provided in this
					 section.
(b) General administration
					 expenses may include, but are not limited to: administrative salaries,
					 including fringe benefits and payroll taxes; home office expenses; compensation
					 of owners, officers or persons other than facility employes; personnel;
					 procurement; accounting; auditing; management consultants; office services and
					 supplies; telephone; licenses; travel; association dues; and legal costs,
					 including attorney's fees.
(c) Home
					 office allocations and management fees are subject to the following conditions
					 and limitations:
(1) Home office allocations
					 and management fees between related parties shall be reported without any
					 markup by the provider.
(2) Costs,
					 such as those related to nonworking officers or officers' life insurance, which
					 are not allowable, may not be included in home office allocations or management
					 fees.
(3) Components of the home
					 office and management costs shall be documented through work time records. If
					 documentation of these costs is not provided to the Department's auditors upon
					 request, the total home office and management costs will be
					 disallowed.
(4) Home office
					 allocations, including depreciation and interest, shall be charged to the
					 general administration line on the cost report.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › SALARY COSTS AND STAFFING STANDARDS › Section 1181.242 - Nursing staff allowance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Except
					 for special rehabilitation facilities, the allowable costs recognized for
					 Medical Assistance may not exceed 3 nursing hours per patient per day for
					 skilled nursing care and 2.6 nursing hours per patient per day for intermediate
					 care.
(b) For special
					 rehabilitation facilities, the allowable costs recognized for Medical
					 Assistance may not exceed 3.75 nursing hours per patient per day for skilled
					 nursing care and 3.2 nursing hours per patient per day for intermediate
					 care.
(c) Allowable nursing hours
					 are calculated in accordance with the instructions of the Department's
					 preprinted cost report.
The provisions of this §
													1181.242 amended under section
						  443.1(2) and (3)
						  of the Public Welfare Code (62 P. S. §
														443.1(2) and
						  (3)).
This section cited in 55 Pa. Code §
													1181.2 (relating to
						  definitions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › SALARY COSTS AND STAFFING STANDARDS › Section 1181.243 - Social service staff

Current through Register Vol. 54, No. 28, July 13, 2024
Cost, pro rata, of up to one full-time equivalent unit of
						social service professional staff for each 60 patients will be allowable.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.251 - Contracted management services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) In lieu of home office allocations and
					 management fees, a facility may contract with a nonrelated management service.
					 The cost of this contract shall be shown as a general administrative cost and
					 may not be allocated among other cost centers.
(b) Management services contracted with a
					 related party will be treated as home office allocations and are subject to
					 §
											1181.234(c)
					 (relating to general administration allowance).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.252 - Volunteer and donated services of individuals

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The actual costs that are necessary for a
					 facility to utilize the services of members of volunteer or religious
					 organizations who donate their services on a regularly scheduled basis to serve
					 in positions customarily held by full-time employes to provide normal patient
					 care or to assist with the operation of the facility will be allowable costs.
					 The following conditions and limitations apply:
(1) The costs shall be limited to the fair
					 market value of comparable salaries of full-time personnel who perform similar
					 services.
(2) The costs shall be
					 based on regular working hours, excluding overtime.
(3) The actual costs for these services shall
					 be supported by documentation substantiating all expenditures.
(4) The costs will be reimbursed as part of
					 the net operating costs.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.253 - Pastoral services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Salary
					 costs will be allowed for pastoral services rendered directly to patients by
					 professional staff employed by, or under contract with, the facility.
(b) Costs for a chaplaincy training program
					 will not be allowable costs.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.254 - Medicare Part B type services

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Facilities shall have the option of using one of two methods of dealing with
					 Medicare Part B services provided by nursing facility owners or operators to MA
					 recipients:
(1)
Option 1.
The nursing facility may exclude from its cost report any operating and capital
					 costs incurred in, and any income derived from, the provision of Medicare Part
					 B services. The nursing facility shall attach, to the cost report the facility
					 submits to the Department, a copy of the cost report the facility submits to
					 Medicare for the Part B services and a copy of the Medicare final audit,
					 including audit adjustments. If final audits are not available, the Department
					 will exclude any operating or capital cost associated with providing the
					 Medicare Part B service.
(2)
Option 2.
The nursing facility may elect, through advance
					 written notification to the Department, to include in its cost report the
					 operating and capital costs incurred in, and the income derived from, the
					 provision of Medicare Part B services. If the nursing facility elects this
					 option, the facility's fiscal year must coincide with that of the Department;
					 and the facility may not change its methodology for Medicare Part B services
					 for the duration of the fiscal year. The Department, at the final settlement,
					 will take the following steps in determining its reimbursement to the facility:
(i) The Department will identify the
					 percentage of the total operating costs represented by the Medicare Part B
					 services and reduce the ceiling on net operating costs for the facility by that
					 percentage.
(ii) The Department
					 will identify and deduct from the total capital costs of the facility the
					 percentage of depreciation and interest costs associated with the provision of
					 Medicare Part B services.
(iii) The
					 Department will apply any revenue received by the facility from Medicare for
					 providing the Part B service as an adjustment to the cost of providing these
					 services before the Department adjusts for the ceiling on net operating costs
					 for the facility.
(3) If
					 the facility did not provide advance written notification to the Department of
					 the facility's election of Option 2 and the facility's cost report contains
					 costs associated with the provision of Medicare Part B services, the Department
					 will credit against the total reimbursement due any revenue the facility
					 received from Medicare for the Part B services rendered to the facility's
					 Medical Assistance recipients.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.254a - Medicare Part B adjustments-statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Option 1
(1) To qualify for Option 1, the facility
					 shall:
(i) Exclude operating and capital costs
					 incurred to provide Medicare Part B services.
(ii) Attach a copy of its Medicare cost
					 report when it submits its MA-11.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.255 - Recreational services

Current through Register Vol. 54, No. 28, July 13, 2024
The cost of recreational services of a facility will be
						allowed and will be based on an hourly or salary rate only, and not on a
						fee-for-service basis.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.256 - Other practitioner services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Other practitioner services which are
					 provided on a contract or salary basis by the facility will be allowed.
					 Arrangements for these services, if made on a fee-for-service basis, will not
					 be allowed.
(b) The direct and
					 indirect costs associated with noncompensable cost centers, such as a pharmacy
					 or space rented or used by an independent practitioner, will not be
					 allowed.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.257 - Drug services

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Allowable costs for drug services will be subject to the following conditions:
(1) A facility will be reimbursed for
					 nonlegend drugs such as laxatives, aspirin, and antacids that are provided
					 directly to an MA patient by a facility from its own supply.
(2) Detailed and itemized support
					 documentation must be maintained for the claimed expense; otherwise, the
					 expense will be disallowed.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.257a - Clarification of the term "written"-statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The term "written" in §
											1181.257(c) 
					 (relating to drug services) includes orders and prescriptions that are
					 handwritten or transmitted by electronic means.
(b) Written orders and prescriptions
					 transmitted by electronic means must be electronically encrypted or transmitted
					 by other technological means designed to protect and prevent access,
					 alteration, manipulation or use by any unauthorized person.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.258 - Utilization, medical review, and program audits

Current through Register Vol. 54, No. 28, July 13, 2024
The cost of services mandated by Federal and State
						regulations for utilization review, medical review, and program audits shall be
						included on the cost report under "Utilization Control" as a separate item
						under "Other Costs."
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.259 - Depreciation allowance

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Depreciation on capital assets used to provide compensable services to Medical
					 Assistance recipients, including assets for normal, standby, or emergency use,
					 is an allowable cost.
(b) Except as
					 specified in subsections (c) and (d), a facility will be reimbursed for
					 allowable depreciation costs only if the facility is the recorded holder of
					 legal title.
(c) Facilities which
					 participated in the Medical Assistance Program prior to July 1, 1983 which are
					 not part of a related organization and which are not the recorded holder of
					 legal title to the facility, are considered to meet the recorded holder of
					 legal title requirement, and, therefore, will be reimbursed for allowable
					 depreciation on a particular project, if, at the time services were rendered,
					 the following existed:
(1) The particular
					 project was wholly funded through an Industrial Development Authority bond
					 issue.
(2) The facility provided
					 the Department with all documents relating to ownership and financial
					 obligations relating to the facility.
(3) The facility met the standards of HIM-15,
					 Section 110-B, with respect to virtual purchases.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.260 - Interest allowance

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Necessary and proper interest on capital and current indebtedness is an
					 allowable cost. The Department will recognize interest as an allowable cost
					 subject to the following conditions:
(1)
					 Interest on new or additional beds is an allowable cost only if one of the
					 following applies:
(i) The facility was
					 issued either a Section 1122 approval or letter of nonreviewability under 28
					 Pa. Code Chapter 301 (relating to limitation on Federal participation for
					 capital expenditures) or a Certificate of Need or letter of nonreviewability
					 under 28 Pa. Code Chapter 401 (relating to Certificate of Need program) for the
					 project by the Department of Health no later than August 31, 1982.
(ii) The facility was issued a Certificate of
					 Need or letter of nonreviewability under 28 Pa. Code Chapter 401 for the
					 construction of a nursing facility, and there was no nursing facility,
					 including county, private or hospital-based, located within the
					 county.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.261 - Bad debt expense

Current through Register Vol. 54, No. 28, July 13, 2024
Bad debts and all associated collection expenses related
						to the bad debts are not allowable costs.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.262 - Fund raising expenses

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Costs
					 pertaining to raising funds for operating expenses and cash flow will be
					 allowed up to 10% of the amount raised.
(b) Fund raising expenses for capital and
					 replacement items up to 5% of the amount raised will be allowed to be
					 capitalized as a part of the cost of the asset under §
											1181.259(h) 
					 (relating to depreciation allowance).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.263 - Costs of related parties

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Related parties that provide services to the general public may furnish
					 services and supplies to a facility under the prudent buyer concept, provided
					 the costs of the services and supplies are consistent with costs of these items
					 furnished by independent third party providers in the same geographic
					 area.
(b) The Department will not
					 recognize as allowable the cost of services provided by related parties if
					 related parties do not provide services to the general public in addition to
					 the facility.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.264 - Rental of property and plant

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Rental expense shall be an allowable net
					 operating cost for the leasing of facilities from related or nonrelated
					 parties. The amount of rental expense allowed during a fiscal year may not
					 exceed the equivalent annual depreciation, computed on the historical cost
					 basis, with depreciation being calculated over the facility's useful life.
					 Historical cost will be established on the basis of either the original
					 construction cost or original purchase price as shown on the lessor's books and
					 records. A maximum of 25% of the equivalent annual depreciation will be allowed
					 if the lessor pays the related costs of ownership. This additional allowance is
					 established upon the documented amount of actual incurred related
					 costs.
(b) Allowable costs for
					 lease purchase agreements and installment sales agreements in which title does
					 not transfer to the lessee will be accounted for in accordance with subsection
					 (a) except as provided otherwise in this subchapter.
(c) For those lease purchase agreements and
					 installment sales agreements in which title transfers to the lessee, Medical
					 Assistance reimbursement for the period of time prior to the date of transfer
					 will be based upon subsection (a). Subsequent to the transfer date, providers
					 shall follow §
											1181.259 (relating to depreciation
					 allowance).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › OTHER COST ITEMS › Section 1181.265 - Prudent buyer concept

Current through Register Vol. 54, No. 28, July 13, 2024
The purchase or rental by a facility of a property,
						plant, equipment, service, supply and the like, may not exceed the cost that a
						prudent buyer would pay in the open market to obtain these items.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › EXPENSES AND REVENUE ITEMS NOT ALLOWABLE IN DETERMINING NET OPERATING COSTS › Section 1181.271 - Excluded expenses and revenues

Current through Register Vol. 54, No. 28, July 13, 2024
In determining the net operating costs of a facility, the
						Department will not allow expenses or revenues relating to:
(1) Nonworking officers' salaries.
(2) Fund raising expenses for capital and
					 replacement items exceeding 5% of the amount raised, and, for operating
					 expenses and cash flow, fund raising expenses exceeding 10% of the amount
					 raised.
(3) Free care or discounted
					 services.
(4) Parties and social
					 activities not related to patient care.
(5) Organizational memberships not necessary
					 to patient care.
(6) Personal
					 telephone service.
(7) Personal
					 radio and television service.
(8)
					 The direct and indirect costs related to nonallowable cost centers including
					 gift, barber, beauty, flower and coffee shops, homes for administrators or
					 pastors, convent areas, and nurses' quarters, except as provided in §
											1181.252 (relating to volunteer
					 and donated services of individuals).
(9) Vending machines.
(10) Charitable contributions.
(11) Employe and guest meals.
(12) Pennsylvania Capital Stock and Franchise
					 Tax.
(13) Income tax.
(14) Ambulance costs.
(15) Promotional advertising, including a
					 yellow page listing that is greater than a minimum insert.
(16) Late payment penalties.
(17) Taxes based upon receivables, revenues
					 or net income.
(18) Officers' and
					 directors' life insurance, including life insurance premiums necessary to
					 obtain mortgages and other loans.
(19) Bad debts or contractual
					 adjustments.
(20) Collection
					 expenses associated with bad debts.
(21) Losses on the sale of fixed and movable
					 assets.
(22) Remuneration of any
					 kind for any purpose including travel expenses for members of the Board of
					 Directors.
(23) Personal laundry
					 services.
(24) Depreciation and
					 interest on capital indebtedness for costs in excess of the per bed
					 limitation.
(25) Expenses or
					 revenues not necessary to patient care.
(26) Net operating or capital cost, including
					 legal fees, accounting and administration costs, travel costs, and the costs of
					 feasibility studies, attributable to the negotiation or settlement of the sale
					 or purchase of a capital asset-by acquisition or merger-for which payment has
					 previously been made under Title XVIII of the Social Security Act
					 (42 U.S.C.A. §§
												1395-1395xx) if the sale or purchase
					 was made on or after July 18, 1984.
The provisions of this §
													1181.271 issued under sections 201
						  and 443.1 of the Public Welfare Code (62 P. S. §§
														201 and
						  443.1).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › EXPENSES AND REVENUE ITEMS NOT ALLOWABLE IN DETERMINING NET OPERATING COSTS › Section 1181.272 - Costs related to revenue producing items

Current through Register Vol. 54, No. 28, July 13, 2024
In determining the operating costs of a facility, the
						Department will not allow costs related to:
(1) The sale of laundry and linen
					 service.
(2) The sale of drugs to
					 nonpatients.
(3) The sale of
					 medical and surgical supplies to nonpatients.
(4) The sale of medical records and
					 abstracts.
(5) The rental of
					 quarters to employes and others.
(6) The rental of space.
(7) Payments received from
					 specialists.
(8) Trade, quantity,
					 time and other discounts on purchases.
(9) Rebates and refunds of
					 expenses.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › EXPENSES AND REVENUE ITEMS NOT ALLOWABLE IN DETERMINING NET OPERATING COSTS › Section 1181.273 - Income that will reduce allowable costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Any form of investment income from the
					 use of unrestricted funds will be used to reduce the allowable interest on
					 capital indebtedness first, then other interest. Any form of investment income
					 from the use of restricted funds found to be used for purposes other than their
					 designated purpose, will be used to reduce the allowable interest on capital
					 indebtedness first, then other interest. If restricted and unrestricted funds
					 are commingled, all income to the common fund will reduce capital indebtedness
					 first, then other interest.
(b)
					 Grants, gifts and income designated by the donor for specific operating
					 expenses will be used to reduce the allowable costs relating to the specific
					 operating expense.
(c) Recovery of
					 insured loss will be used to reduce the allowable costs relating to the insured
					 loss.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter B - MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES › EXPENSES AND REVENUE ITEMS NOT ALLOWABLE IN DETERMINING NET OPERATING COSTS › Section 1181.274 - Direct provider payments not includable in costs

Current through Register Vol. 54, No. 28, July 13, 2024
Costs for prescription drugs, physicians', dental,
						dentures, podiatry, eyeglasses, appliances, X-rays, laboratory and any other
						materials or services covered by payments made directly to providers other than
						facilities under Medical Assistance and Medicare including Part B, Champus,
						Blue Cross, Blue Shield or other insurers or third parties shall not be
						allowable in determining net operating costs.
This section cited in 55 Pa. Code §
													1181.254a (relating to Medicare
						  Part B adjustments-statement of
						  policy).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › GENERAL › Section 1181.501 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This subchapter provides information on the
						implementation of OBRA-87 provisions pertaining to nursing home reform due for
						implementation by January 1, 1989, including notices of Federal requirements
						for nursing home providers and statements of policy.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › GENERAL › Section 1181.502 - Scope

Current through Register Vol. 54, No. 28, July 13, 2024
This subchapter affects skilled nursing facilities and
						intermediate care facilities-but not intermediate care facilities for the
						mentally retarded-participating as providers or seeking to enroll as providers
						in the Medical Assistance Program; persons-and their families-seeking admission
						to the facilities; persons employed or seeking employment by the facilities as
						nurse aides; and persons or entities providing or intending to provide training
						and competency evaluations for nurse aides employed by the facilities. This
						subchapter addresses the application of requirements established by Federal law
						to be effective January 1, 1989.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › GENERAL › Section 1181.503 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this
						subchapter, have the following meanings, unless the context clearly indicates
						otherwise:
Department
-The Department of Public
						Welfare of the Commonwealth.
LAMP
-The Long Term Care Assessment and
						Management Program.
OBRA-87
-Subtitle C of the Omnibus Budget
						Reconciliation Act of 1987 (42 U.S.C.A. §§
												1395i-3,
						1395x,
						1396a note, 1396b, 1396b note,
						1396o, 1396r, 1396r note, 1396r-3 note, 1396s).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › GENERAL › Section 1181.505 - Discussion

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This subchapter
					 is the first of a series involving the implementation of OBRA-87. Since the
					 implementation of OBRA-87 is to be phased over several years, the Department
					 will be issuing statements of policy and other documents in advance of the
					 implementation of State and Federal requirements to provide information on
					 Department policy with respect to the requirement, to announce Department
					 regulations and to describe procedures and resources for compliance. Since the
					 implementation of OBRA-87 involves coordination with policies established by
					 the United States Department of Health and Human Services (HHS) under the law,
					 publications may also be required to update or revise standards in light of
					 announcement of HHS criteria and regulations.
(b) This subchapter deals with five areas:
(1) Conditions of participation affecting
					 providers of nursing home services that are being added by OBRA-87.
(2) The Nurse Aide Registry System being
					 established by the Department of Health in cooperation with the
					 Department.
(3) The Nurse Aide
					 Training and Competency Evaluation Program being established by the Department
					 of Education in cooperation with the Department.
(4) The Preadmission Screening Program for
					 persons seeking admission to nursing facilities.
(5) The appeals process for persons adversely
					 affected by the Preadmission Screening Program.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › NURSE AIDE TRAINING AND COMPETENCY EVALUATION PROGRAM › Section 1181.521 - Nurse aide training and competency evaluation system

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Section 1396r(e)(1)(A) of 42 U.S.C.A.
					 provides: "The State must by not later than January 1, 1989, specify those
					 training and competency evaluation programs and those competency evaluation
					 programs, that the State approves for purposes of (42 U.S.C.A. §
												1396r(b)(5)) and that meet
					 the requirements established under (42 U.S.C.A. §§
												1396r(f)(2)(A)(i) or
					 (ii))."
(b) For purposes of
					 42 U.S.C.A. §
												1396r(e)(1)(A):
(1) "The Secretary (of HHS) shall establish,
					 by not later than September 1, 1988, requirements for the approval of nurse
					 aide training and competency evaluation programs, including requirements
					 relating to the areas to be covered in such a program (including at least basic
					 nursing skills, personal care skills, recognition of mental health and social
					 service needs, basic restorative services, and residents' rights), content of
					 the curriculum; minimum hours of initial and ongoing training and retraining
					 (including not less than 75 hours in the case of initial training);
					 qualifications of instructors; and procedures for determination of
					 competency."
(2) "Requirements for
					 the approval of nurse aide competency evaluation programs, including
					 requirements relating to the areas to be covered in such a program, including
					 at least basic nursing skills, personal care skills, cognitive, behavioral and
					 social care, basic restorative services, and residents' rights, and procedures
					 for determination of competency."