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COMMONWEALTH OF PENNSYLVANIA

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Pennsylvania Code



Subchapter C. COST REPORTING AND AUDIT REQUIREMENTS


Sec.


1189.71.    Cost reporting.
1189.72.    Cost reporting for Medicare Part B type services.
1189.73.    Accountability requirements related to resident personal fund management.
1189.74.    Auditing requirements related to resident personal fund management.
1189.75.    Auditing requirements related to MA cost report.

§ 1189.71. Cost reporting.

 (a)  A county nursing facility shall submit an acceptable MA cost report to the Department within 120 days following the close of each calendar year in a form and manner specified by the Department. Requests for an extension to file an annual cost report will not be granted except as provided under §  1189.1 (relating to policy).

 (b)  An acceptable MA cost report is one that meets the following requirements:

   (1)  Applicable items are fully completed in accordance with the instructions provided for the cost report including the necessary original signatures on the required number of copies.

   (2)  Computations carried out on the cost report are accurate and consistent with other related computations.

   (3)  The treatment of cost conforms to the applicable requirements of this chapter.

   (4)  Required documentation is included.

   (5)  The cost report is filed with the Department within the time limits specified.

§ 1189.72. Cost reporting for Medicare Part B type services.

 (a)  County nursing facilities shall utilize Medicare as a primary payer resource when appropriate, under §  1189.102 (relating to utilizing Medicare as a resource).

 (b)  If Medicare is the primary payer resource, the county nursing facility shall exclude from allowable costs operating costs incurred in or income derived from the provision of Medicare Part B coverable services to nursing facility residents. The county nursing facility shall attach to the MA cost report a copy of the cost report the nursing facility submits to Medicare for the Part B services and, when available, submit a copy of the Medicare final audit, including audit adjustments.

 (c)  If there is a discrepancy between the costs on the Medicare cost report or, if available, the Medicare audit report, and the adjustments made by the county nursing facility on the MA cost report to exclude Medicare Part B costs, the Department will make the necessary adjustments to conform the county nursing facility’s MA cost report to the Medicare report.

§ 1189.73. Accountability requirements related to resident personal fund management.

 (a)  A county nursing facility may not require residents to deposit their personal funds with the county nursing facility. A county nursing facility shall hold, safeguard and account for a resident’s personal funds upon written authorization from the resident in accordance with this section and other applicable provisions in State and Federal law.

 (b)  A resident’s personal funds may not be commingled with county nursing facility funds or with the funds of a person other than another resident.

 (c)  A resident’s personal funds in excess of $50 shall be maintained in an interest bearing account, and interest earned shall be credited to that account.

 (d)  A resident’s personal funds that do not exceed $50 may be maintained in a noninterest bearing account, interest bearing account or petty cash fund.

 (e)  Statements regarding a resident’s financial record shall be available upon request to the resident or to the resident’s legal representative.

 (f)  The county nursing facility shall notify each resident that receives MA benefits when the amount in the resident’s personal fund account reaches $200 less than the SSI resource limit for one person.

 (g)  Within 60 days of the death of a resident, the county nursing facility shall convey the resident’s funds and a final accounting of those funds to the individual or probate jurisdiction administering the resident’s estate.

 (h)  The county nursing facility may not impose a charge against the personal funds of a resident for an item or service for which payment is made under MA or Medicare.

 (i)  The county nursing facility shall maintain records relating to its management of residents’ personal funds for a minimum of 4 years. These records shall be available to Federal and State representatives upon request.

 (j)  The county nursing facility shall purchase a surety bond or otherwise provide assurances of the security of personal funds of the residents deposited with the county nursing facility.

§ 1189.74. Auditing requirements related to resident personal fund management.

 (a)  The Department will periodically audit residents’ personal fund accounts.

 (b)  If discrepancies are found at audit, the county nursing facility shall make restitution to the residents for funds improperly handled, accounted for or disbursed. The Department may sanction the nursing facility in accordance with Chapter 1187, Subchapter I (relating to enforcement of compliance for nursing facility services).

§ 1189.75. Auditing requirements related to MA cost report.

 (a)  The Department will conduct an audit of each acceptable MA cost report with an end date of December 31, 2005, and thereafter to determine the county nursing facility’s allowable MA Program expenditures for the calendar year.

 (b)  To determine the county nursing facility’s audited allowable MA Program expenditures for a calendar year, the Department will audit the county nursing facility’s MA cost report for compliance with:

   (1)  This chapter.

   (2)  Chapter 1101 (relating to general provisions).

   (3)  The schedules and instructions included in the MA cost report.

 (c)  A county nursing facility shall make financial and statistical records to support its MA cost reports available to the Department upon request and to other State and Federal representatives as required by Federal and State law and regulations.

 (d)  The Department will conduct audits in accordance with auditing requirements in Federal regulations and generally accepted government auditing standards.

 (e)  A county nursing facility that has certified financial statements, Medicare intermediary audit reports with adjustments and Medicare reports for the reporting period shall submit these reports with its cost report, at audit or when available.



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