Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1163 - INPATIENT HOSPITAL SERVICES › Subchapter B - HOSPITALS AND HOSPITAL UNITS UNDER COST REIMBURSEMENT PRINCIPLES › PAYMENT FOR COST REIMBURSED HOSPITAL SERVICES › Section 1163.453 - Allowable and nonallowable costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Payment for cost reimbursed inpatient
					 hospital services is based on the allowable cost for the services in this
					 section.
(b) Unless clearly
					 specified to the contrary in this chapter, allowable costs for the MA Program
					 are computed under Medicare principles under the Social Security Act
					 (42 U.S.C.A. §§
												301-1397f) and Federal regulations and
					 instructions.
(c) The Department
					 may not make payment for a service at a rate higher than the hospital's
					 customary charge. For the purpose of this chapter, the hospital's customary
					 charge is the usual charge to the general public for a specific
					 service.
(d) Costs not allowable
					 under the MA Program are:
(1) Costs exceeding
					 the limits established by the Department of Health and Human Services under
					 Medicare regulations set forth at
					 42 CFR
					 413.30 (relating to limitations on
					 reimbursable costs).
(2) Costs
					 related to the provision of a noncompensable service or item under §
												1163.455 (relating to
					 noncompensable services and items).
(3) Costs related to depreciation and
					 interest for rehabilitation hospitals unless the hospital was one of the
					 following:
(i) Constructed prior to July 1,
					 1983.
(ii) Issued either a Section
					 1122 approval letter 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 June 30, 1983. The Department will not
					 recognize depreciation or interest as an allowable cost if the facility does
					 not substantially implement the project as defined at 28 Pa. Code §
													401.5(j)(2)
					 (relating to Certificate of Need) within the effective period of the original
					 Section 1122 approval or the original certificate of need.
(4) Costs for legal services relating to
					 litigation against the Commonwealth, including administrative appeals, if the
					 litigation is finally decided in favor of the Commonwealth.
(5) Costs for relocating or housing
					 employes.
(6) Telephone, television
					 and radio services in patient rooms.
(7) Personal care and maternity
					 kits.
(8) Costs related to
					 depreciation and interest for providers reimbursed under this subchapter except
					 for medical rehabilitation units unless:
(i)
					 An application for a certificate of need for the new or additional beds has
					 been approved by the Department of Health, with an effective date of June 30,
					 1986, or earlier. In order for the facility to receive payment, the project
					 shall be substantially implemented as defined at 28 Pa. Code §
													401.5(j)(2) 
					 within the effective period of the certificate of need.
(ii) A letter nonreviewability has been
					 issued on or before June 30, 1986.
(9) For medical rehabilitation units, costs
					 related to capital costs for new or additional beds unless one of the following
					 applies:
(i) The new or additional medical
					 rehabilitation beds were placed in service prior to July 1, 1988, and are
					 located in a medical rehabilitation unit which was enrolled in the MA Program
					 with an effective date no later than July 1, 1988. This includes beds which are
					 one of the following:
(A) Located in a unit
					 which has applied to the Medicare Program for exclusion prior to July 1, 1988
					 and completes its 12-month evaluation period prior to July 1, 1989.
(B) Placed in service during the 12-month
					 Medicare evaluation period ending prior to July 1, 1989.
(C) Covered in Medicare's initial letter of
					 exclusion related to those beds.
(ii) Either a Section 1122 approval or letter
					 of nonreviewability under 28 Pa. Code Chapter 301 or a certificate of need or
					 letter of nonreviewability under 28 Pa. Code Chapter 401 for the new or
					 additional medical rehabilitation unit beds was issued by the Department of
					 Health no later than June 30, 1988. In addition, the project shall have been
					 substantially implemented as defined at 28 Pa. Code §
													401.5(j)(2)
					 within the effective period of the original Section 1122 approval or the
					 original certificate of need, including one 6-month extension period.