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Pennsylvania Code (Last Updated: April 5, 2016) |
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Title 55. PUBLIC WELFARE |
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PART III. Medical Assistance Manual |
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Chapter 1181. Nursing Facility Care |
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SubChapter B. MANUAL FOR ALLOWABLE COST REIMBURSEMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITIES |
Section 1181.212. General principles
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(a) A facility’s direct or indirect allowable costs related to patient care will be considered in the finding and allocation of costs to the MA Program for its eligible recipients.
(b) Total allowable costs of a facility will be apportioned between third-party payors and other patients so that, within the limits of this subchapter, the share borne by MA under Title XIX of the Public Health Service Act, 42 U.S.C. Chapter 6A, Subchapter XIX is based upon those actual services and costs related to MA recipients.
(c) Within the limits of this subchapter, allowable costs include those costs necessary to provide skilled or intermediate care. These may include costs related to all of the following:
(1) Dietary and food.
(2) Laundry.
(3) Housekeeping.
(4) Plant operation and maintenance.
(5) Nursing.
(6) Director of nursing.
(7) Related clerical staff.
(8) Practitioners.
(9) Medical director.
(10) Utilization and medical review.
(11) Social services.
(12) Patient activities.
(13) Volunteer services.
(14) Over-the-counter drugs.
(15) Medical supplies.
(16) Physical, occupational and speech therapy.
(17) Oxygen.
(18) Rent.
(19) Amortization.
(20) Other interest.
(21) Insurance.
(22) Real estate taxes.
(23) Equipment rental.
(24) Depreciation.
(25) Interest on capital indebtedness.
(d) In certain cases under MA principles, there may be more than one method for handling a cost item. In these cases the method initially elected by the provider shall be followed consistently in subsequent reporting periods except as provided in this subchapter.
The provisions of this § 1181.212 adopted August 5, 1983, effective July 1, 1983, 13 Pa.B. 2402.
Notation
Insurance premiums paid on liability policies for the protection of directors and officers of a facility were not ‘‘renumeration’’ but were related to patient care and therefore could be allowed as a reimbursement cost under Medicaid. Mercury-Douglass Center, Inc. v. Department of Public Welfare, 601 A.2d 913 (Pa. Cmwlth. 1992).