La. Admin. Code tit. 50 § XXI-717

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXI-717 - Non-allowable Costs

A. Costs that are not based on the reasonable cost of services covered under Medicare and are not related to the care of participants are considered non-allowable costs.

B. Reasonable cost does not include the following:

1. costs not related to participant care;

2. costs specifically not reimbursed under the program;

3. costs that flow from the provision of luxury items or services (items or services substantially in excess or more expensive than those generally considered necessary for the provision of the care);

4. costs that are found to be substantially out of line with other centers that are similar in size, scope of services, and other relevant factors;

5. costs exceeding what a prudent and cost-conscious buyer would incur to purchase the goods or services.

C. General non-allowable costs:

1. services for which Medicaid participants are charged a fee;

2. depreciation of non-participant care assets;

3. services that are reimbursable by other state or federally funded programs;

4. goods or services unrelated to participant care;

5. unreasonable costs.

D. Specific non-allowable costs (this is not an all-inclusive listing):

1. advertising-costs of advertising to the general public that seeks to increase participant utilization of the ADHC center;

2. bad debts-accounts receivable that are written off as not collectible;

3. contributions-amounts donated to charitable or other organizations;

4. courtesy allowances;

5. director's fees;

6. educational costs for participants;

7. gifts;

8. goodwill or interest (debt service) on goodwill;

9. costs of income producing items such as fund raising costs, promotional advertising, or public relations costs, and other income producing items;

10. income taxes, state, and federal taxes on net income levied or expected to be levied by the federal or state government;

11. insurance, officers-cost of insurance on officers, and key employees of the center when the insurance is not provided to all employees;

12. judgments or settlements of any kind;

13. lobbying costs or political contributions, either directly or through a trade organization;

14. non-participant entertainment;

15. non-Medicaid related care costs-costs allocated to portions of a center that are not licensed as the reporting ADHC or are not certified to participate in Title XIX;

16. officers' life insurance with the center or owner as beneficiary;

17. payments to the parent organization or other related party;

18. penalties and sanctions-penalties and sanctions assessed by the Centers for Medicare and Medicaid Services, LDH, the Internal Revenue Service or the state Tax Commission;

19. insufficient funds charges;

20. personal comfort items; and

21. personal use of vehicles.

La. Admin. Code tit. 50, § XXI-717

Promulgated by the Department of Health, Bureau of Health Services Financing, the Office for Citizens with Developmental Disabilities and the Office of Aging and Adult Services, LR 471119 (8/1/2021).

The provisions of this Section were previously located in LAC 50:XXI.2909.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.