C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS › Subpart F—Specific Categories of Costs

42 C.F.R. § 413.102

Compensation of owners

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(a) Principle. A reasonable allowance of compensation for services of owners is an allowable cost provided that the services are actually performed in a necessary function.

(b) Definitions—(1) Compensation. Compensation means the total benefit received by the owner for the services he furnishes to the institution. It includes the following items:

(i) Salary amounts paid for managerial, administrative, professional, and other services.

(ii) Amounts paid by the institution for the personal benefit of the proprietor.

(iii) The cost of assets and services that the proprietor receives from the institution.

(iv) Deferred compensation.

(2) Reasonableness. Reasonableness requires that the compensation allowance—

(i) Be such an amount as would ordinarily be paid for comparable services by comparable institutions; and

(ii) Depend upon the facts and circumstances of each case.

(3) Necessary. Necessary requires that the function be—

(i) Such that had the owner not furnished the services, the institution would have had to employ another person to perform the services; and

(ii) Pertinent to the operation and sound conduct of the institution.

(c) Application. (1) Owners of provider organizations often furnish services as managers, administrators, or in other capacities. In such cases, it is equitable that reasonable compensation for the services furnished to be an allowable cost. To do otherwise would disadvantage such owners in comparison with corporate providers or providers employing persons to perform similar services.

(2) Ordinarily, compensation paid to proprietors is a distribution of profits. However, if a proprietor furnishes necessary services for the institution, the institution is in effect employing his services, and a reasonable compensation for these services is an allowable cost. In corporate providers, the salaries of owners who are also employees are subject to the same requirements of reasonableness. If the services are furnished on less than a full-time basis, the allowable compensation should reflect an amount proportionate to a full-time basis. Reasonableness of compensation may be determined by reference to, or in comparison with, compensation paid for comparable services and responsibilities in comparable institutions; or it may be determined by other appropriate means.

Notes of Decisions
Cited in 5 cases, 1999–2001 · leading case: AllCare Home Health, Inc v. Shalala, 278 F.3d 1087 (10th Cir. 2001).
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AllCare Home Health, Inc v. Shalala, 278 F.3d 1087 (10th Cir. 2001). “According to the regulations, “Reasonableness of compensation may be determined by reference to, or in comparison with, compensation paid for comparable services and responsibilities in comparable institutions; or it may be determined by other appropriate means.”
High Country Home Health, Inc. v. Shalala, 123 F. Supp. 2d 1275 (D. Wyo. 1999). · cites it 3× “Where services are furnished on a less than full-time basis, allowable compensation must reflect an amount proportionate to a full-time basis, citing 42 C.F.R. § 413.102 (c)(2). Additionally, the owner-administrator claimed a salary amount of $70,001, plus add-on compensation…”
Call a Nurse, Inc. v. Shalala, 59 F. Supp. 2d 938 (E.D. Mo. 1999). “With regard to the Norwoods' salaries, the Secretary determined that reliance on the Michigan Survey complied with agency regulation 42 C.F.R. § 413.102 (c)(2) which provides that "reasonableness of [owner] compensation may be determined by reference to, or in comparison with,…”
High Country Home Health, Inc. v. Shalala, 123 F. Supp. 2d 1275 (D. Wyo. 1999). · cites it 3× “Where services are furnished on a less than full-time basis, allowable compensation must reflect an amount proportionate to a full-time basis, citing 42 C.F.R. § 413.102 (c)(2). Additionally, the owner-administrator claimed a salary amount of $70,001, plus add-on compensation…”
AllCare Home Health, Inc. v. Shalala, 108 F. Supp. 2d 1161 (D. Colo. 2000). “” 42 C.F.R. § 413.102 (a). Section 902 of the Medicare Provider Reimbursement Manual (“PRM”) allows for such compensation in an “amount determined to be the reasonable value of the services rendered regardless of whether there is any actual distribution of the profits of the…”
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