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 1181.211 - Cost reimbursement principles and method

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Subject to the limitations and sanctions
					 specified in Subchapter A (relating to nursing facility care), a facility will
					 be reimbursed its allowable net operating costs, plus allowable depreciation
					 and interest on capital indebtedness.
(b) The amount of MA reimbursement for
					 allowable operating costs, excluding depreciation and interest, will not exceed
					 the level of net 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 laws and quality and
					 safety standards.
(c) Costs that
					 are not recognized as allowable costs in a fiscal year may not be carried
					 forward or backward to other fiscal years for inclusion in allowable
					 costs.
(d) Long-term care
					 disproportionate share allowance payments are made according to a formula
					 established by the Department to general nongovernmental long-term care
					 facilities in which skilled and intermediate Medicaid funded patient days
					 account for at least 90% of total patient days. Payment of the long-term care
					 disproportionate share allowance is contingent upon the express appropriation
					 by the General Assembly, of funds designated to make payments of this
					 allowance.
(e) County nursing
					 facility disproportionate share payments are made according to a formula
					 established by the Department to county nursing facilities, in which Medicaid
					 funded resident days account for at least 80% of the facility's total resident
					 days and the number of certified MA beds is greater than 270 beds. Payment of
					 the county nursing facility disproportionate share payment for the period July
					 1, 1995, through December 31, 1995, is contingent upon the determination by the
					 Department that there are sufficient State and Federal funds appropriated to
					 make these allowance payments. County nursing facility disproportionate share
					 payments will not be limited to or affected by any ceilings or net operating
					 costs, charges to private pay residents, peer group or facility-specific
					 payment limits under the MA Program.
(f) For the period July 1, 1995, through
					 December 31, 1995, the Department will make program enhancement payments to
					 general and county nursing facilities participating in the MA Program as
					 follows. The Department will increase the interim per diem rate for the nursing
					 facility to reflect inflation by 2% up to the ceilings on allowable net
					 operating costs and subject to the upper limits on payments in accordance with
					 §
											1181.68 (relating to upper limits
					 of payment).
See 22 Pa.B. 3749 (July 18, 1992) for nursing home
						  pulling provisions.
The provisions of this §
													1181.211 amended under sections
						  201, 403 and 443.1(2) and (3) of the Public Welfare Code (62 P. S. §§
														201,
						  403 and
						  443.1(2) and
						  (3)).
This section cited in 55 Pa. Code §
													1181.101 (relating to facility's
						  right to a hearing).