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PDFWAC 388-835-0405

What are unallowable costs?

(1) Costs are unallowable if they are not documented, necessary, or ordinary and do not relate to providing services to ICF/ID residents.
(2) Examples of unallowable costs include, but are not limited to, the following:
(a) Costs of items or services not covered by the medicaid program. Costs of nonprogram items or services will not be allowed even if indirectly reimbursed by DSHS as a result of an authorized reduction in resident contribution.
(b) Costs of services and items provided to ICF/ID residents covered by DSHS's medical care program but not included in ICF/ID services.
(c) Costs associated with a capital expenditure subject to Section 1122 approval (part 100, Title 42 C.F.R.) if DSHS found the expenditure was not consistent with applicable standards, criteria, or plans. If DSHS was not given timely notice of a proposed capital expenditure, all associated costs will not be allowed as of the date the costs were determined to be nonreimbursable under applicable federal regulations.
(d) Costs associated with a construction or acquisition project that requires certificate of need approval according to chapter 70.38 RCW and that approval was not obtained.
(e) Costs associated with outside activities (e.g., costs allocable to the use of a vehicle for personal purposes, or related to the part of a facility leased out for office space).
(f) All salaries or other compensation of officers, directors, stockholders, and others associated with the provider or home office, except compensation paid for services related to resident care and training.
(g) Costs in excess of limits set in this chapter or costs violating principles contained in this chapter.
(h) Costs resulting from transactions or the application of accounting methods used to circumvent the principles of the prospective cost-related reimbursement system.
(i) Costs applicable to services, facilities, and supplies furnished by a related organization in excess of the lower of cost to the related organization or market meaning the price paid for comparable services, facilities or supplies when purchased in an arms length transaction.
(j) Balances of accounts that cannot be collected (bad debts or uncollectable accounts).
(k) Charity and courtesy allowances.
(l) Cash, assessments, or other contributions to political parties, and cost incurred to improve community or public relations. Dues to charitable organizations, professional organizations and trade associations are allowable costs.
(m) Any portion of trade association dues for legal and consultant fees and costs related to lawsuits or other legal action against DSHS.
(n) Travel expenses for trade association boards of directors in excess of the twelve allowable meetings per calendar year.
(o) Vending machine expenses.
(p) Expenses for barber or beautician services not included in routine care.
(q) Funeral and burial expenses.
(r) Costs of gift shop operations and inventory.
(s) Personal items such as cosmetics, smoking materials, newspapers and magazines, and clothing, except items used in resident activity programs or in ICF/ID programs where clothing is a part of routine care.
(t) Fund-raising expenses except those directly related to the resident activity program.
(u) Penalties and fines.
(v) Expenses related to telephones, televisions, radios, and similar appliances in a resident's private accommodations.
(w) Federal, state, and other income taxes.
(x) Costs of special care services, except where authorized by DSHS.
(y) Expenses for "key-person" insurance and other insurance or retirement plans not available to all employees.
(z) Expenses of profit-sharing plans.
(aa) Expenses related to the purchase and/or use of private or commercial aircraft that exceed what a prudent provider would spend for ordinary and economical transportation when conducting resident care business.
(bb) Personal expenses and allowances of owners or relatives.
(cc) All expenses of maintaining professional licenses or membership in professional organizations.
(dd) Costs related to agreements not to compete.
(ee) Goodwill and the amortization of goodwill.
(ff) Expenses related to vehicles in excess of what a prudent provider would expend for the ordinary and economic provision of transportation needs related to resident care.
(gg) Legal and consultant fees related to a fair hearing against DSHS. Including but not limited to, fees for accounting services used to prepare for an administrative judicial review resulting in a final administrative decision favorable to DSHS or where DSHS's decision is allowed to stand.
(hh) Legal and consultant fees related to a lawsuit against DSHS, including suits appealing administrative decisions.
(ii) Lease acquisition costs and other intangibles not related to resident care and training.
(jj) Interest charges assessed by the state of Washington for failure to make timely refund of overpayments and interest expenses incurred for loans obtained to make such refunds.
(kk) Travel expenses outside the states of Idaho, Oregon, and Washington and the Province of British Columbia except travel to and from the home and central office of a chain organization operation outside those areas if the travel is necessary, ordinary, and related to resident care and training.
(ll) Moving expenses of employees when a demonstrated, good-faith effort has not been made to recruit employees within the states of Idaho, Oregon, and Washington and Province of British Columbia.
[Statutory Authority: RCW 71A.12.030 and 44.04.280. WSR 15-09-069, § 388-835-0405, filed 4/15/15, effective 5/16/15. Statutory Authority: RCW 71A.20.140. WSR 01-10-013, § 388-835-0405, filed 4/20/01, effective 5/21/01.]
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