N.Y. Comp. Codes R. & Regs. Tit. 10 § 86-4.21 - Allowable costs
(a) To be
considered as allowable in determining reimbursement rates, costs must be
actual, reasonable and properly chargeable to necessary patient care. Except as
otherwise provided in this Part, or in accordance with specific determination
by the commissioner, allowable costs shall be determined by the application of
the principles of reimbursement developed for determining payments under the
title XVIII (Medicare) program.
(b)
Allowable costs shall not include costs for services that have not been
approved by the commissioner.
(c)
Allowable costs shall include a monetary value assigned to services provided
under contract by religious orders and to services rendered by an owner and
operator of a facility or an operator's relatives in accordance with section
86-4.27
of this Subpart.
(d) Allowable
costs may not include amounts in excess of reasonable or maximum title XVIII
(Medicare) costs or in excess of customary charges to the general public. This
provision shall not apply to services furnished by public providers free of
charge or at a nominal fee. Allowable costs shall not include any amount for
bad debts.
(e) Allowable costs
shall not include expenses or portions of expenses reported by individual
facilities which are determined by the commissioner not to be reasonably
related to the efficient production of service because of either the nature or
amount of the particular item.
(f)
Allowable costs shall not include costs which principally afford diversion,
entertainment or amusement to facility owners, operators or
employees.
(g) Allowable costs
shall not include any interest charged or penalty imposed by governmental
agencies or courts, or the costs of policies obtained solely to insure against
the imposition of such penalties.
(h) Allowable costs shall not include the
direct or indirect costs of advertising (except help-wanted ads), public
relations and promotion. Reasonable direct and indirect costs of outreach
services designed to attract patients in need of medical services shall be
allowable.
(i) Allowable costs
shall not include costs or contributions or other payments to political
parties, candidates or organizations.
(j) Allowable costs shall include only that
portion of the dues paid to any professional association which has been
determined by the commissioner to be allocable to expenditures other than for
public relations, advertising and political contributions.
(k) Allowable costs shall not include any
element of cost determined by the commissioner to have been created by the sale
of a facility.
(l) Allowable costs
shall include the cost of services incurred by the facility's staff to provide
offsite services to registered patients of the facility. Allowable costs shall
not include the cost of offsite services provided to nonregistered patients or
the cost of services provided through arrangements with other facilities. When
the cost of such services cannot be established, income from such services
shall be used to adjust allowable costs.
(m) Allowable costs shall include the cost of
National Health Service Corps personnel, based upon the liability incurred by
the facility for the report period, not actual expenditures for the personnel
during the report period.
(n)
Allowable costs shall not include the cost of ordered ambulatory services. When
the cost of such services cannot be determined, income from the services may be
used to adjust allowable costs.
(o)
Allowable costs may include certain costs not normally covered under Medicare
(title XVIII of the Social Security Act), including but not limited to the cost
of dental services, patient transportation, prescription drugs, eyeglasses,
prosthetic or orthotic devices, podiatry services.
(p) Allowable costs shall not include the
costs of education services, including special classroom programs for preschool
and school-age children unable to attend public schools, unless such services
are medically necessary.
(q)
Allowable costs shall include the costs of recreational services rendered in
accordance with a physician's plan of treatment. The costs of recreational
services that provide leisure activities shall not be allowable.
(r) Allowable costs shall not include costs
related to inpatient services rendered by hospitals or services related to
living accommodations in a residential treatment program.
(s) All research costs shall be excluded from
allowable costs. Research shall include those studies and projects which have
as their purpose the enlargement of general knowledge and understanding, are
experimental in nature and hold no prospect of immediate benefit to the
facility or its patients.
(t) The
costs of educational activities for employees, less tuition paid or reimbursed
by other than the facility and supporting tuition or related grants, shall be
allowable, provided such activities are directly related to patient care
services.
Notes
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