§ 1187.51. Scope.
(a) This subchapter sets forth principles for determining the allowable costs of nursing facilities.
(b) The Medicare Provider Reimbursement Manual (CMS Pub. 15-1) and the Federal regulations in 42 CFR Part 489 (relating to provider and supplier agreements) appropriate to the reimbursement for nursing facility services under the Medicare Program are a supplement to this chapter. If a cost is included in this subchapter as allowable, the CMS Pub. 15-1 and applicable Federal regulations may be used as a source for more detailed information on that cost. The CMS Pub. 15-1 and applicable Federal regulations will not be used for a cost that is nonallowable either by a statement to that effect in this chapter or because the cost is not addressed in this chapter or in the MA-11. The CMS Pub. 15-1 or applicable Federal regulations will not be used to alter the treatment of a cost provided for in this subchapter or the MA-11.
(c) The Department’s payment rate for nursing facility services to eligible residents in participating nursing facilities includes allowable costs for routine services. Routine services may include the following:
(1) Regular room, dietary and nursing services, social services and other services required to meet certification standards, medical and surgical supplies and the use of equipment and facilities.
(2) General nursing services, including administration of oxygen and related medications, hand feeding, incontinency care, tray service and enemas.
(3) Items furnished routinely and uniformly to residents, such as resident gowns, water pitchers, basins and bedpans.
(4) Items furnished, distributed to residents or used individually by residents in small quantities such as alcohol, applicators, cotton balls, bandaids, antacids, aspirin (and other nonlegend drugs ordinarily kept on hand), suppositories and tongue depressors.
(5) Reusable items furnished to residents, such as ice bags, bed rails, canes, crutches, walkers, wheelchairs, traction equipment and other durable medical equipment.
(6) Special dietary supplements used for tube feeding or oral feeding, such as elemental high nitrogen diet, even if written as a prescription item by a physician.
(7) Basic laundry services.
(8) Nonemergency transportation.
(9) Beauty and barber services.
(10) Other special medical services of a rehabilitative, restorative or maintenance nature, designed to restore or maintain the resident’s physical and social capacities.
(d) Nursing facilities will receive payment for allowable costs in four general cost centers:
(1) Resident care costs.
(2) Other resident related costs.
(3) Administrative costs.
(4) Capital costs.
(e) Within the limits of this subchapter, allowable costs for purposes of cost reporting include those costs necessary to provide nursing facility services. These may include costs related to the following:
(1) Resident care costs.
(i) Nursing.
(ii) Director of nursing.
(iii) Related clerical staff.
(iv) Practitioners.
(v) Medical director.
(vi) Utilization and medical review.
(vii) Social services.
(viii) Resident activities.
(ix) Volunteer services.
(x) Over-the-counter drugs.
(xi) Medical supplies.
(xii) Physical, occupational and speech therapy.
(xiii) Oxygen.
(xiv) Beauty and barber.
(xv) Supplies and minor movable property acquired during cost report periods beginning on or after January 1, 2001, used in a nursing facility in the course of providing a service or engaging in an activity identified in this paragraph.
(2) Other resident related costs.
(i) Dietary, including food, food preparation, food service, and kitchen and dining supplies.
(ii) Laundry and linens.
(iii) Housekeeping.
(iv) Plant operation and maintenance, including the repair, maintenance and service of movable property.
(v) Supplies and minor movable property acquired during cost report periods beginning on or after January 1, 2001, used in a nursing facility in the course of providing a service or engaging in an activity identified in this paragraph.
(3) Administrative costs.
(i) Administrator.
(ii) Office personnel.
(iii) Management fees.
(iv) Home office costs.
(v) Professional services.
(vi) Determination of eligibility.
(vii) Advertising.
(viii) Travel/entertainment.
(ix) Telephone.
(x) Insurance.
(xi) Interest other than that disallowed under § 1187.59(a)(24) (relating to nonallowable costs).
(xii) Legal fees.
(xiii) Amortization—administrative costs.
(xiv) Supplies and minor movable property acquired during cost report periods beginning on or after January 1, 2001, used in a nursing facility in connection with an activity identified in this paragraph.
(4) Capital costs.
(i) Assigned cost of fixed property.
(ii) Acquisition cost of major movable property.
(iii) Real estate tax cost.
Authority The provisions of this § 1187.51 amended under sections 201(2), 206(2), 403(b) and 443.1(5) of the Public Welfare Code (62 P.S. § § 201(2), 206(2), 403(b) and 443.1(5)).
Source The provisions of this § 1187.51 amended February 8, 2002, effective July 1, 2001, 32 Pa.B. 734; amended June 23, 2006, effective July 1, 2006, 36 Pa.B. 3207; amended November 26, 2010, effective November 27, 2010, 40 Pa.B. 6782. Immediately preceding text appears at serial pages (351453) to (351454) and (320623).
Cross References This section cited in 55 Pa. Code § 1187.57 (relating to selected capital cost policies).
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