Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 7346 (November 25, 2023).

55 Pa. Code § 6211.42. Allowable costs.

§ 6211.42. Allowable costs.

 (a)  A facility’s direct or indirect allowable costs related to client care are considered in the finding and allocation of costs to the MA Program for its eligible recipients.

 (b)  Total allowable costs of a facility shall be apportioned between third-party payors and other clients so that, within the limits of this subchapter, the share borne by MA under Title XIX of the Social Security Act (42 U.S.C.A. § §  1396—1396p) is based upon those actual services and costs related to MA clients. Allowable costs shall be apportioned by multiplying the interim per diem cost by the number of eligible client days for MA clients.

 (c)  The provider is responsible for the accounting of all costs and services. All miscellaneous costs shall be documented and justified to the Department. Allowable costs do not include charity, in-kind and courtesy allowances.

 (d)  If, under MA principles, there is more than one method for handling a cost item, the method initially elected by the provider shall be followed consistently in subsequent reporting periods, unless there is prior written justification and approval from the Department for using a different method.

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