Table of Content
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. 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. A facility providing more than one level of care shall allocate the total administrative costs to each level of care on the basis of a percentage of the costs of each level of care to the total costs. 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.

The patient was absent from the facility for a continuous 24-hour period from May 4, 1987 at 11 a.m. It is not unreasonable for the Department of Public Welfare to recoup overpayments made for services actually rendered following a provider or recipient appeal when the Department of Public Welfare’s reclassifications are sustained. Centennial Spring Health Care Centers v. Department of Public Welfare, 541 A.2d 806 (Pa. Cmwlth. 1988). The Department will send a written notice of the authorization or denial of payment to the nursing facility and the patient.
APPENDIX FHEAVY CARE/INTERMEDIATE SERVICES
Copies of previous discharge summaries—during the past 2 years. If the history and physical examination used for the PASARR Determination is not performed by a physician, then a physician’s countersignature is required. Rehabilitative nursing procedures, including related teaching and adaptive aspects of nursing, that are part of active treatment.
The Department of Public Welfare, through its medical assistance program, will reimburse for interest expenses and properly concluded that imputation of interest was necessary in reviewing an interest free loan made by a nursing care facility to its president. To be considered allowable, necessary and proper, the interest expense shall be incurred and paid within 90 days of the close of the cost reporting period on a loan made to satisfy a financial need of the facility and for a purpose reasonably related to patient care. After July 1, 1977, allowable depreciation costs for existing, new, renovated or purchased facilities shall be limited to a maximum construction cost per bed of $22,000. If an existing facility constructs additional beds or renovates portions of the facility which include supportive services, such as a dining room, physical therapy room, occupational therapy room, or maintenance area, the cost of construction of these supportive services is prorated among both existing and new beds of the facility. A separate $22,000 per bed limit applies to each construction or renovation project.
PAYMENT FOR NURSING FACILITY CARE
On the second copy of the summary report, the administrator will give written responses to each area identified as deficient and all narrative recommendations. Recipient needs continued placement in the facility or there is an appropriate plan to transfer to an alternate level of care. The services are available and adequate to meet the recipient’s health needs. The facility’s net operating per diem is subject to the MSA or non-MSA group ceiling for county facilities.

The Department of Education will manage the review and approval of nurse aide training and competency evaluation programs and of nurse aide competency evaluation programs required by OBRA-87. The Department of Education will be the source for information about those programs and the agency responsible for determining nurse aide competency. Compensation of owners, officers or persons other than facility employes means actual payment during the cost reporting period on a current basis of salary or benefits for services rendered to the facility. 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.
Liaison with nursing home physician in
A person eligible for Medical Assistance will not be charged fees or copayments as part of the preadmission screening process, either by the nursing facility or by another agency or department. A person who is not eligible for Program benefits may be charged, but at no more than cost. Fair Acres Geriatric Center v. Department of Public Welfare, 528 A.2d 1008 (Pa. Cmwlth. 1987). The cost of general administrative salaries and benefits are included within the 12% overall maximum allowance, prorated between skilled nursing and intermediate care units, for general administration costs. 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. 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.
Staffing requirements that nursing home visits to visit may compensate us improve these visits shall be required to individuals as requiring specific regulatory requirements. If the services cannot be brought into the facility, the nursing home must help the resident arrange transportation to and from the service location. Kaiser permanente care homes require nursing homes and visits should visit requires meticulous organizational and local laws and revise its unique procedure act may prescribe adaptive or required.
This subchapter addresses the application of requirements established by Federal law to be effective January 1, 1989. A recipient receiving skilled nursing care, intermediate care or intermediate care for the mentally retarded—except a recipient in a State-operated intermediate care facility for the mentally retarded—is eligible for a maximum 15 consecutive reserved bed days per hospitalization. The Department will pay a facility at a rate of one-third of the facility’s current interim per diem rate on file with the Department for a hospital reserved bed day.

This additional allowance is established upon the documented amount of actual incurred related costs. The cost of providing Medicare Part B type services to non-Medicare Part B eligible recipients which are otherwise allowable costs under this part should be reported as provided elsewhere in this subchapter. 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.
CMS Compliance Group, Inc. is a regulatory compliance consulting firm with extensive experience servicing the post-acute/ long term care industry. With the idea of continuous quality improvement in mind, CMSCG's interdisciplinary team ensures that all departments can achieve and maintain compliance while improving quality of care. LICA-MedMan, LLC reserves the right to make changes to this site, the disclaimers, and the terms and conditions at any time. And may be performed prior to the initial comprehensive visit as permitted under state laws.

For purposes of MA reimbursement, the return on net equity and net worth is not reimbursable. Effective with dates of service on and after January 1, 1992, an MA eligible nursing facility resident that is in a Medicare benefit period, fully paid days or coinsurance days, or both, is eligible for a maximum of 15 consecutive reserved bed days per hospitalization. The Department will reimburse a nursing facility at 1/3 of the facility’s current interim per diem rate on file with the Department, for a hospital reserved bed day when a resident is hospitalized during a Medicare benefit period. A recipient receiving skilled nursing care is eligible for a maximum of 15 days per calendar year for therapeutic leave outside the facility if the leave is included in the individual’s plan of care and is ordered by the attending physician. If the attending physician recommends a change in the recipient’s level of care to the intermediate level of care, the attending physician shall document the change in the recipient’s medical record and notify the Department of the level of care change on the Attending Physician Request for Change Summary form. For recipients receiving skilled nursing care, the attending or staff physician and other personnel involved in the care of the recipient shall review each plan of care at least every 60 days and document the date of the review in the record of the patient.
Nonpaid workers shall be members of an organization of nonpaid workers that has arrangements with the provider for the performance of services by nonpaid workers. Allowable nursing hours are calculated in accordance with the instructions of the Department’s preprinted cost report. 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. The nursing home’s new 180 bed facility was not a ‘‘new facility’’ allowing for the application of the minimum bed occupancy allowance rule used in the determination of depreciation expense in that the home has been in existence since 1873. Lemington Home for the Aged v. Department of Public Welfare, 641 A.2d 637 (Pa. Cmwlth. 1994).

Skilled planning and management activities are not always specifically identified in the recipient’s clinical record. Therefore, if the recipient’s overall condition supports a finding that recovery and safety can be assured only if the total care is planned, managed and evaluated by technical or professional personnel, it is appropriate to infer that skilled services are being provided. The Department is required under OBRA-87 to determine, with respect to individuals who are mentally ill or mentally retarded—including those with other related conditions—and require nursing facility services, whether those individuals require active treatment for their condition. The Department is required to base this determination on the data collected as part of the evaluation process conducted by the Department of Aging.
Our Services
If the resident fails to produce evidence to show that the provider facility’s decision is in error, the Department shall affirm the decision. In order to assist providers in meeting the requirements established by OBRA-87 with respect to residents’ transfer and discharge rights, the Department is establishing guidelines for the definition of terms contained in OBRA-87 and for the implementation of the procedures required by the law. The Department has developed criteria to be used in determining whether an applicant or recipient is medically eligible for the heavy care/intermediate level of care. To be determined medically eligible for the heavy care/intermediate level of care, a recipient shall meet the requirements in Section II. If any one of the requirements specified in Section II are not met, the recipient cannot be determined to be medically eligible for the heavy care/intermediate level of care. The Department will issue a determination within 5 working days of its receipt of Form PA-PASARR-EV from the evaluation agency. Subject to the cooperation of the applicant, the evaluation agency will complete the evaluation and file Form PA-PASARR-EV with the Department as soon as possible after its receipt of Form PA-PASARR-ID from the nursing facility.
Enforcement of conditions of participation established by OBRA-87 and effective for current nursing facility providers. 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.