§ 1151.52. Payment for capital costs not included in the base year.
(a) Inpatient psychiatric facilities which place a new capital project into service after the base year, as determined under § 1151.46 (relating to payment rate calculations for Fiscal Years 1993-94 and 1994-95), are entitled to payment for certain capital costs, if the qualifying criteria, outlined under this section, are met.
(b) This additional payment applies only to capital projects with an approval date of either a Certificate of Need or letter of nonreviewability on or before June 30, 1991.
(c) To apply for an additional capital payment, an inpatient psychiatric facility shall submit documentation sufficient to enable the Department to verify that the requirements of this section are met.
(d) To be eligible for an additional capital payment, the costs related to a capital project shall meet the following criteria:
(1) The costs shall represent increases in the inpatient psychiatric facility’s allowable depreciation and interest costs for a fixed asset that was entered in the inpatient psychiatric facility’s fixed asset ledger in the year being audited.
(2) The costs shall be attributable to a fixed asset that is both of the following:
(i) Approved for Certificate of Need on or before June 30, 1991, under 28 Pa. Code Chapter 301 or 401 (relating to limitations on Federal participation for capital expenditures; and Certificate of Need Program), or not subject to review for Certificate of Need as evidenced by a letter of nonreviewability dated on or before June 30, 1991.
(ii) Related to patient care in accordance with Medicare standards.
(e) For an inpatient psychiatric facility to qualify for an additional capital payment set forth in this section, the following criteria shall be met:
(1) The inpatient psychiatric facility’s rate of increase in overall audited costs shall exceed 15%. The Department will establish this rate of increase by comparing the inpatient psychiatric facility’s audited costs for the fiscal year to its audited costs for the preceding fiscal year.
(2) The inpatient psychiatric facility’s rate of increase for allowable depreciation and interest shall exceed its rate of increase for net operating costs. The Department will determine the rate of increase in an inpatient psychiatric facility’s net operating cost by comparing the inpatient psychiatric facility’s audited net operating costs for the fiscal year to its audited net operating costs for the preceding fiscal year. The Department will determine the rate of increase in an inpatient psychiatric facility’s depreciation and interest costs by:
(i) Determining the inpatient psychiatric facility’s allowable audited depreciation and interest costs for the preceding fiscal year, including costs excluded in the preceding fiscal year under subsection (b).
(ii) Adding the amount allowable under subsection (b) for the fiscal year being audited to the amount determined under subparagraph (i).
(iii) Comparing the amounts determined under subparagraphs (i) and (ii) to determine the rate of increase.
(f) For Fiscal Years 1993-94 and 1994-95, for each inpatient psychiatric facility which requests an additional capital payment, the Department will audit its MA Cost Reports for the fiscal year for which the request is made, the prior fiscal year and subsequent fiscal years for which additional capital payment is requested. To the extent that the facility is determined eligible to receive an additional capital payment under this section, the following applies:
(1) For each fiscal year the Department will compare the total MA payments for inpatient psychiatric services paid to the inpatient psychiatric facility for that fiscal year (the ‘‘total payment’’) with the inpatient psychiatric facility’s actual MA costs for inpatient psychiatric services as determined at audit, including the allowable capital costs eligible under this section (the ‘‘actual costs’’).
(2) If the amount of actual costs exceeds the total payment, the Department will pay the inpatient psychiatric facility the difference between the actual costs and the total payment, not to exceed the amount of allowable capital costs.
(3) If the amount of actual costs does not exceed the total payment, the Department will not pay the inpatient psychiatric facility any additional capital payment.
(4) The Department will not recoup or offset any additional capital payment made under this section.
Source The provisions of this § 1151.52 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2796; amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 3665; reserved June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial page (181789).
Cross References This section cited in 55 Pa. Code § 1151.46 (relating to payment rate calculations for Fiscal Years 1993-94 and 1994-95).
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