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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Nursing Facilities (Hospital Based) Cost Reports

Hospital-Based Nursing Facility providing Long Term (INC) and/or (SNC) Level of Care

Contact Information:

Michael D'Alessio or Bob Young
919-814-0030
Email: Mike.DAlessio@dhhs.nc.gov or Bob.Young@dhhs.nc.gov

Through proposed State Plan Amendment language and collaboration with the industry, NCDHHS has directed DMA to transition the cost report medium from FoxPro software to the CMS cost reporting software and all providers will use applicable CMS 2540 / CMS 2552 cost reporting forms plus NC Medicaid Supplemental Schedules as described below. 

IMPORTANT NOTICE: Transition to CMS 2540-10 and 2552-10 Cost Reporting formats for FYE 9/30/2012. See the attached memo for more details.

IMPORTANT NOTICE: NCDHHS has directed DMA to transition the cost report medium from FoxPro Cost Reporting Software to the CMS cost reporting software and to include supplemental schedules as necessary to comply with North Carolina State Plan reimbursement regulations. As a result, all providers will transition to the use of CMS 2540-10 / CMS 2552-10 cost reporting forms plus NC Medicaid Supplemental Schedules as described in the instructions.

For cost report periods ending on or after October 1, 2011, hospital based nursing facility providers will file full 12 month cost reports using the CMS 2552-10 cost reporting forms plus the NC Medicaid Supplemental Schedules and the cost report period will be the provider’s normal fiscal year end as registered with Medicare.

For free-standing providers who have a fiscal year end other than 9/30/2011 (such as a 12/31/2011 provider), this will create an overlap of 2011 cost report periods. The Division recognizes this overlap; however, it is necessary during this transition year. Costs from this overlapping period will not be used for rate setting or rebase purposes.

Health Care Assessments and Nurse Aide Training costs for the non-overlapping period will be settled.

You will need to download the “SNF 2012 Instructions_Version 3” document as it contains specific DMA requirements that must be followed when preparing the “NC NF Supplemental Cost Report 2012 – Version 3” Excel cost reporting forms.

The free Adobe Acrobat Reader is required to view and print PDF files.

Hospital-Based Nursing Facility with FYE 2012 through December 31, 2012

For questions directly related to the new NC NF Medicaid Supplemental Cost Report Schedules, you may download the (pdf) file using the following link - NC NF Medicaid Supplemental Cost Report FAQS (PDF, 52 KB)

Hospital-Based Nursing Facility with FYE 2011 through December 31, 2011

If you need more information about the FoxPro cost reporting software system requirements needed, please read the Software Installation Instructions.

Chart of Accounts for prospective Hospital-based nursing facility cost reports

Frequently Asked Questions

  1. Will DMA grant an extension for filing a cost report beyond the due date? DMA does not plan to grant extensions except in the case of natural disasters, i.e. fire, floods etc.  Otherwise, cost reports must be filed by the due date. See the Cost Report Extension (21 KB) memo for further explanation.
  2. If I need to amend a cost report after it has been filed, what are the steps to do this? DMA does not normally permit amended cost reports except under certain circumstances.
    3. li>When is the Medicaid cost report for Hospital-based Nursing facilities due to be filed?
    Hospital-based Nursing facility cost reports must be filed no later than five months (150 days) after the facility FYE or concurrently with the Medicare cost report.
  3. If my Hospital-based nursing facility has low Medicaid utilization, will we automatically be exempted from filing a Medicaid cost report?
    No, a yearly written waiver request must be sent to the DMA Audit Section (attn: Michael D'Alessio, Audit Manager). You may e-mail to Mike.DAlessio@dhhs.nc.gov or send a fax using FAX number 919-715-4711.
  4. What are the established cost limitations for the Hospital-based NF having a fiscal year ending on or after September 30, 2003?
    The cost limitations are as follows:
    Director's Fees: $2,400 annually or $200 per meeting
    Owner or Administrator Salary:
    $57,097 (1-50 beds)
    $69,336 (51-99 beds)
    $73,414 (100-149 beds)
    $79,006 (150-199 beds)
    $89,724 (200-249 beds)
    Do not make adjustments for these limitations. The Audit Section will review and apply limitations.
  5. (FY2011 and Earlier) On the Hospital-based nursing facility cost report, are the compensation amounts reported on Schedule A-3 based on DMA limitation amounts?
    No, compensation reported on the Hospital-based cost report, Schedule A-3, should not be based on DMA limitation amounts. Report compensation after any applicable adjustments on Schedule A-2 for non-allowable amounts.The Audit Section will review compensation and apply limitations. Do NOT make adjustments to the Hospital-based nursing facility filed cost report for the DMA limitations.
  6. (FY2011 and Earlier)If the hospital CEO functions as the nursing facility administrator, is a portion of the CEO’s salary allocated to the nursing facility?
    No, the salary for the CEO functioning as the nursing facility administrator is reported in the Administrative and General Cost Center. Administrative and General Cost Center expenses are indirect expenses allocated on Schedule B to the appropriate cost center line.