Section 51.73. Cost report requirements

(a) A provider of cost-based services shall submit a cost report as instructed by the Department.

(b) A provider who has one Master Provider Index number shall submit one cost report for that Master Provider Index number.

(c) A provider with multiple Master Provider Index numbers may submit one cost report for all of its Master Provider Index numbers or one cost report for each Master Provider Index number.

(d) Information on the cost report must meet the following:

(1) The cost report must accurately reflect:

(i) The actual cost of the HCBS provided.

(ii) The allowable administration fee for the HCBS provided.

(2) An allowable cost must meet the requirements in § 51.81 (relating to allowable costs).

(e) A cost report or a cost report addenda must:

(1) Comply with the Department’s cost report instructions.

(2) Be consistent with this chapter.

(3) Be on a form prescribed by the Department.

(4) Be submitted to the Department by the provider on or before the last business day in the second week of November for nontransportation cost-based services and on or before the last business day in the third week of February for transportation cost-based services as provided in the cost report instructions.

(f) A provider shall do the following to obtain approval of a cost report:

(1) Submit a completed cost report by the due date established by the Department as indicated in the cost report instructions. The cost report must contain information for the development of a cost-based rate as required under this section.

(2) Pass the Department’s desk review process.

(3) Include an audit, if required under § 51.46 (relating to audit requirements).

(4) Submit a revised cost report if a provider’s audited financial statement differs from a provider’s cost report.

(g) When applicable, a provider of a cost-based service shall allocate allowable costs, both eligible and ineligible appropriately in accordance with OMB Circular A-122 or any approved revisions to the OMB Circular A-122.

(h) The Department or the Department’s designee will review the cost report for completeness and accuracy based on the Department’s cost report instructions.

(i) The Department will use the cost-based rate-setting methodology to establish a rate for cost-based services for each provider with an approved cost report.

(j) The Department will publish the cost-based rate-setting methodology as a public notice in the Pennsylvania Bulletin.

(k) The Department will use the providers’ approved cost report as the initial factor in the rate setting methodology to develop the allowable costs for cost-based services.

Notation

Cross References

This section cited in 55 Pa. Code § 51.48 (relating to provider in the Adult Autism Waiver); 55 Pa. Code § 51.71 (relating to definitions); and 55 Pa. Code § 51.74 (relating to approval of a cost-based rate for nontransportation HCBS).