N.H. Code Admin. R. He-E 806.05

Current through Register No. 25, June 20, 2024

Section He-E 806.05 - Reimbursement Based on Actual Allowable Costs

The department shall reimburse NF's based an actual allowable costs as follows:

(a) To be allowable, costs, including compensation, shall be reasonable and necessary for services related to resident care and pertinent to the operation of the NF as described below:

(1) To be reasonable, the compensation shall be such as would ordinarily be paid for comparable services by comparable facilities, for example, facilities of similar size and level of care; and

(2) To be necessary, the service shall be such that had the individual not rendered the services, another person would have had to have been employed to perform the same services;

(b) Allowable costs for services and items directly related to resident care, pursuant to He-E 802, shall be included in the per diem rate unless the service or item is reimbursable under Medicare or covered by the drug rebate program through the department;

(c) The following costs shall not be allowable:

(1) Costs that are a result of inefficient operations, such as the hiring of a consultant to assist in daily operations due to management practices which could or did result in the loss of the facility's license to operate;

(2) Costs resulting from unnecessary or luxurious care, such as purchasing a luxury sedan when a utilitarian sedan would suffice for the transportation of residents;

(3) Costs related to activities not common and accepted in a NF, as determined by the department, in comparison to other facilities, such as purchasing an airplane; and

(4) Costs or financial transactions conceived for the purpose of circumventing the provisions of He-E 806, such as listing an employee with a job title that would be reimbursable under Medicaid, but the job duties actually performed by the employee are not reimbursable under Medicaid;

(d) To be an allowable cost of compensation, services shall actually be performed by the individual and paid in full to the individual by the NF provider;

(e) If services are provided on a less than full-time basis, as determined by the NF, allowable compensation shall be based on the percent of time for which the service is actually provided;

(f) Costs incurred to comply with changes in federal or state laws, rules or regulations for enhanced direct and indirect resident care services and improved facilities administration shall be considered allowable costs; and

(g) Allowable or non-allowable costs for specific services or items shall be determined as described in He-E 806.06 through He-E 806.30.

N.H. Code Admin. R. He-E 806.05

#8547, eff 1-24-06 (formerly He-W 593.08 )