55 Pa. Code § 1151.45 - Nonallowable costs

Costs not allowable under the MA Program are:

(1) Costs exceeding the limits established by the Department of Health and Human Services under Medicare regulations at 42 CFR 413.30 (relating to limitations on reimbursable costs).

(2) Costs related to the provision of a noncompensable service or item listed in § 1151.48 (relating to noncompensable services and items).

(3) Inpatient costs related to preadmission laboratory tests, radiology services and other diagnostic services provided to recipients who are not admitted to the hospital as planned.

(4) Costs for legal services relating to litigation against the Commonwealth, including administrative appeals, if the litigation is ultimately decided in favor of the Commonwealth.

(5) Costs for relocating or housing employes.

(6) Costs for which Federal financial participation (FFP) is precluded by statute, except as may be expressly provided for otherwise in this chapter.

(7) Capital costs related to new or additional beds unless an application for a Certificate of Need for the new or additional beds has been approved by the Department of Health, with an effective date of June 30, 1991, or earlier. For the facility to receive payment, the project shall be substantially implemented as defined by applicable Department of Health regulations within the effective period of the Certificate of Need.

(8) Capital costs related to new or additional beds unless a letter of nonreviewability has been issued on or before June 30, 1991.

(9) Capital costs for replacement beds, unless the facility received a Certificate of Need as defined at section 701 of the Health Care Facilities Act (35 P. S. § 448.701) for replacement beds. To be recognized as allowable, the replacement beds shall physically replace beds in the same facility, capital costs related to the beds being replaced shall have been recognized as allowable and the project shall be substantially implemented as defined by applicable Department of Health regulations within the effective period of the original Section 1122 approval or the original Certificate of Need, plus one 6-month extension period.

Notes

55 Pa. Code § 1151.45

The provisions of this § 1151.45 adopted September 30, 1983, effective 7/1/1983, 13 Pa.B. 2796; amended February 28, 1986, effective 3/1/1986, 16 Pa.B. 660; amended November 7, 1986, effective 7/1/1986, 16 Pa.B. 4384; amended June 16, 1989, effective immediately and applies retroactively to July 1, 1988; amended June 18, 1993, effective 7/1/1993, 23 Pa.B. 2917; amended October 29, 1993, effective 7/1/1993, 23 Pa.B. 5241.

The provisions of this § 1151.45 amended under sections 201 and 443.1(1) and (4) of the Public Welfare Code (62 P. S. §§ 201 and 443.1(1) and (4)).