Nursing Facility Cost Report – Long-term Skilled or Intermediate Nursing Care Home Office or Related Party Support

Home office or related party organizations that support nursing facilities providing long-term skilled nursing care or intermediate nursing care are required to report financial information to Medical Assistance.

IMPORTANT NOTICE

Providers with a home office must file the CMS 287 (Home Office) cost reporting forms per the Centers for Medicare and Medicaid Services (CMS) Publication 15, Section 3903. Providers must file a hard copy.

Providers with a related organization that is not subject to CMS 287 requirements must complete Worksheet A-8-1 per Medicare cost reporting principles. Medical Assistance will audit this accordingly and request supplemental information to ensure that only actual cost is reported and profit has been removed.

Providers with related organization/home office costs in CMS cost reporting schedules must submit a hard copy of the provider’s related organization/home office cost report.

FYE 2015

Nursing facility providers will file full 12-month cost reports using the CMS 2540-10 cost reporting forms plus the NC Medicaid Supplemental Schedules. The cost report period will be the provider's normal fiscal year end as registered with Medicare.

Download “SNF 2015 Instructions Version 5” for Medical Assistance requirements that must be followed when preparing the “NC NF Supplemental Cost Report 2015 – Version 5” Excel cost reporting forms.

Home Office/Related Organization with a 2015 FYE on or before 12/31/2015

State-owned Nursing Facility FYE 06/30/2015

State-owned/operated skilled nursing facility providers file annual Medicaid cost reports with Medical Assistance using the CMS 2540 cost reporting schedules. Cost reports are due within 5 months after the provider's fiscal year end.

State-owned/operated provider-based nursing facilities file annual Medicaid cost reports with Medical Assistance using the CMS 2552 cost reporting schedules. Cost reports are due within 5 months after the provider's fiscal year end or 37 days from the date of the hospital's PS&R, whichever is later.

Cost Limitations for FY 2015

  • 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)

Contact

Medical Assistance Finance Section
Michael D’Alessio
Phone: 919-814-0030
Fax: 919-814-0031

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