Chapter 514 - Nursing Facility Services - DHHR - State of West ...

514.13.32 Damage Awards and Negotiated SettlementsLiability damages paid by the provider, either imposed by law or assumed by contract, whichshould reasonably have been covered by liability insurance, are not allowable. Any settlementnegotiated by the provider or award resulting from a court or jury decision of damages paid bythe provider in excess of the limits of the provider's policy, as well as the associated legaldeductibles or legal costs is non-allowable.514.13.33 Reorganization/Refinancing CostsOrganization and reorganization costs are the costs incurred in the creation or restructuring ofan entity. These costs are considered to be non-allowable for cost reporting and reimbursementpurposes.514.13.34 Purchases From Related Companies or OrganizationsAll related companies or organizations involved in any business transactions with the facilitymust be identified on the cost report. Detailed data must be available in the facility recordswhich describe the kind and extent of such business transactions. Cost for purchase of anyitems or services from related companies or organizations will be allowed at the actual cost ofproviding the service or the price of comparable services purchased elsewhere, whichever isless. The facility must maintain and make available, upon request for desk review or audit,detailed documentation that the related party purchase has been included in the cost report atthe related party’s cost and any calculations to demonstrate that any inter-company profit thatwould have passed to the related party from the transaction has been eliminated in the costreport preparation.514.13.35 Filing Reports – Requests for AssistanceFinancial and statistical reports and questions regarding cost reporting are to be addressed toWVDHHR Office of Accountability and Management Reporting; Attention: Division of Audit andRate Setting, #1 Davis Square, Suite 304, Charleston, WV 25301.514.13.36 Rate DeterminationIndividual facility rates are established on a prospective basis, considering costs to be expectedduring the rate period. The rate is not subject to retrospective revision. This does not excludecorrections for errors of omissions of data or reconciliation of audit findings related tofalsification or misreporting of costs or census. The basic vehicle for arriving at each facility’srate is the uniform Financial and Statistical Report for Nursing Homes.The reported costs are subject to desk review and then converted to cost per patient day.Rates will be issued for six month periods beginning April 1 and October 1 based on eachfacility’s reported costs and adjustments for the applicable reporting period.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 65January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.