MEDICAID SUPPLEMENTAL DATA

Section 446.37 - Cost allocation adjustments

MEDICAID SUPPLEMENTAL DATA

446.37 Cost allocation adjustments.

Account Adjustment Cost center affected number

(a) Depreciation--replacement cost to historical cost

(1) Buildings and fixtures Depreciation and Amortization-- Fixed Assets 8810

(2) Equipment Depreciation and Amortization-- Movable Equipment 8820

(b) Depreciation--accelerated Depreciation and Amortization-- to straight line-- Fixed Assets 8810 buildings and fixtures

(c) Interest on inter-fund borrowing

(1) Funded depreciation (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(2) Donor-restricted funds (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(3) Other (specify) (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(d) Unincorporated business Provision for Income Taxes 9410 tax

(e) Corporate income tax Provision for Income Taxes 9410

(f) Unrecovered cost of Employee Benefits--Non courtesy allowances to Payroll-Related employees and dependents 8830

(g) Voluntary Agency Proficiency Testing Program

(1) Clinical laboratory Laboratory Services--Clinical 7210

(2) Other (specify) Specify Specify

(h) Grants, gifts and income for specific purpose Specify Specify

(i) Professional standards Medical Care Review 8740 review organization

Other (specify) Specify Specify

(j) Amounts may be expressed as:

(1) increases; or

(2) decreases.
 

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Section 446.38 - Funded depreciation calculation

446.38 Funded depreciation calculation. (a) Calculation to determine extent of depreciation funding.

(1) Total depreciation expense for reporting period:

(i) Depreciation and Amortization--Fixed Assets (account 8810), plus

(ii) Depreciation and Amortization--Movable Equipment (account 8820).

(2) Source and amount of cash disbursed for capital assets:

(i) Unrestricted Fund (exclude borrowed from outside sources).

(ii) Specific purpose funds.

(iii) Plant replacement and expansion funds.

(iv) Endowment funds.

(3) Payments made during year to reduce capital debt (principal only).

(4) Change in composition of depreciation fund balance.

Subtract balance at the end of the prior reporting period from balance at the end of the current reporting period for total assets, total liabilities and fund balances.

(5) Maximum allowable depreciation expense:

(i) Take the total amount of cash disbursed for capital assets.

(ii) Add payments made to reduce capital debt.

(iii) Add or subtract increase or decrease in depreciation fund balance.

(6) Depreciation not funded:

(i) If maximum allowable depreciation expense exceeds or is equal to total depreciation expense reported, depreciation has been fully funded.

(ii) If maximum allowable depreciation expense is less than total depreciation expense reported, the depreciation funding requirement has not been met.

(b) Total depreciation expense for the reporting period (paragraph (a)(1) of this section) should reflect Medicaid adjustments (section 446.37 of this Part).
 

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Section 446.39 - Funded depreciation waiver

446.39 Funded depreciation waiver.

(a) If funding requirement is not met, do you wish to apply for a waiver?

(b) If so, the following information must be provided:

(1) A narrative of the reasons for your request.

(2) Provide the status of your unrestricted resources:

(i) Does the hospital have unrestricted funds temporarily serving as specific purpose funds, plant replacement and expansion funds, or endowment funds?

(ii) Does the hospital have restricted funds temporarily serving as specific purpose funds, plant replacement and expansion funds, or endowment funds?

(iii) If any question is answered yes, the amounts must be reported.
 

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Section 446.40 - Rent and equity

446.40 Rent and equity.

(a) Does any rent expense you reported remain in the New York State Cost Allocation process?

(1) Leases and Rentals--Fixed Assets (account 8815); or

(2) Leases and Rentals--Movable Equipment (account 8825) .

(b) If yes, report the following:

(1) For each lessor organization, report the amount of rent expense:

(i) fixed assets, separately from

(ii) movable equipment.

(2) Provide the name of the lessor organization and indicate if:

(i) you have an arm's length arrangement, or

(ii) a non-arm's length arrangement.

(c) If a non-arm's length arrangement exists, the owner/lessor must provide:

(1) Actual expense relative to the asset leased/rented:

(i) Depreciation.

(ii) Mortgage interest.

(iii) Insurance.

(iv) Property taxes.

(v) Other (specify).

(2) Condensed balance sheet relative to the asset leased/rented:

(i) Total assets.

(ii) Total liabilities.

(iii) Total capital (equity).

(d) Definition of non-arm's length arrangement.

(1) Operator of proprietary facility has more than a 10 percent interest in the equity of a company providing real property, goods or services to the facility.

(2) An interest in the equity means an operator has ownership or control, direct or indirect, in such a company.
 

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Section 446.41 - Hospital-based home health agencies

446.41 Hospital-based home health agencies.

(a) Hospitals desiring rates for HHS services must:

(1) Provide the Home Health Agency NYS Operating Certificate Number; and

(2) Ratio of Charges to Charges Applied to Costs (RCCAC) information.

(b) RCCAC information.

(1) Statistics required:

(i) Number of hours of service.

(ii) Number of home health visits.

(iii) Charge per visit at the hospital's established rates.

(iv) Multiply number of home visits by the charge per visit.

(2) Specific home health services for which statistics above are required:

(i) Skilled Nursing Care (account 6910).

(ii) Medical Social Services (account 6920).

(iii) Home Health Aides (account 6930).

(iv) Physical Therapy (account 7510).

(v) Occupational Therapy (account 7530).

(vi) Speech/Language Pathology (account 7550).

(vii) Other Home Health Services (account 6990).

(3) The total charges calculated in paragraph (b) (1) of this section must be summed for all services in paragraph (b) (2) of this section.

(4) A percentage of each service in paragraph (b) (2) of this section to the total charges in paragraph (b) (3) of this section must be calculated (to the nearest tenth of a percent).

(c) Show visits and charges only for approved HHA services.

(d) Does your hospital contract for any HHA services?

(1) If so, is charge dependent on the amount charged by the contracting agency?

(2) If so, detail the visits and charges according to each contract under paragraph (b)(2) of this section.
 

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Section 446.42 - Ambulance service

446.42 Ambulance service.

(a) The costs of this service, regardless of how it is provided, must be reported as follows:

(1) As an ambulatory program service.

(2) Under account 6850--Ambulance Services.

(b) Data to be reported if the service exists.

(1) Does this service apply to Medicaid recipients in the same manner as all other recipients of this service?

(2) If not, explain:

(i) Reason for this policy.

(ii) Extent that Medicaid Service has been excluded from the amount reported.
 

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Section 446.43 - Physician cost

446.43 Physician cost.

(a) Please refer back to section 440.6(e)(4)(vii)(c)(3) of this Article.

(b) The requirements indicated there for Blue Cross apply equally to Medicaid.
 

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