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Resource Use (Cost/Utilization) Measurement and Reporting in Pennsylvania

        Pennsylvania has an independent state agency named the Health Care Cost Containment Council that requires various providers to report to it certain medical cost data.1  Hospitals and ambulatory service facilities must file audited and certified financial statements each year, as well as quarterly utilization and financial reports to the council.2

        In addition to the Cost Containment Council, hospitals must submit financial and cost reports annually to the Department of Welfare that includes all information necessary for the proper determination of costs payable under the program, including financial records and statistical data.3  Likewise, nursing facilities4 and Inpatient Psych Facilities5 must submit cost reports to the Department that identifies costs of services, facilities and supplies furnished by organizations related to the provider by common ownership or control.

 

Footnotes

  • 1. 35 Pa. Stat. Ann. § 449.6 (West 2010)
  • 2. 28 Pa. Code § 912.61 (2012), 28 Pa. Code § 912.62 (2012)
  • 3. 55 Pa. Code § 1163.64 (2012)
  • 4. 55 Pa. Code § 1181.64 (2012), 55 Pa. Code § 1187.71 (2012)
  • 5. 55 Pa. Code § 1151.47 (2012)

 

Resource Use (Cost/Utilization) Measurement and Reporting in Pennsylvania

Subtopic Statute/Regulation Description
Resource Use (Cost/Utilization) Measurement and Reporting Annual audited financial statements - 28 Pa. Code § 912.61 Hospitals and ambulatory service facilities must annually file audited and certified financial statements within 120 days after the close of the...
Annual cost reporting - 55 Pa. Code § 1151.47 Inpatient psychiatric facilities must complete form MA 336 (Financial Report for Hospital and Hospital-Health Care Complex Under the Medical...
Cost reporting - 55 Pa. Code § 1181.64 Each nursing facility must submit a cost report to the department of welfare within 90 days of the close of each fiscal year.  The cost report...
Cost reporting - 55 Pa. Code § 1187.71 Nursing facilities must report costs to the medical assistance program by filing an acceptable MA-11 with the department of welfare, which includes...
Cost reports - 55 Pa. Code § 1163.64 Hospitals must complete form MA 336 (Financial Report for Hospital and Hospital-Health Care Complex Under the Medical Assistance Program of the...
Data submission and collection - 35 Pa. Stat. Ann. § 449.6 The health care cost containment council is authorized to collect and providers must submit all data required under this section. The council may...
Medicare cost reports and Medical Assistance Form 336 - 28 Pa. Code § 912.63 Hospitals and ambulatory care facilities must quarterly report summary utilization and financial reports to the council. 28 Pa. Code Chapter 912,...
Required data elements - 28 Pa. Code § 912.21 Health care facilities must quarterly submit the following data elements:1         Those contained in health...