Payments to Nursing Facilities; 1998-1999 Final Rates
[29 Pa.B. 6062]
The purposes of this notice are to announce: the final payment rates for nursing facilities beginning July 1, 1998, October 1, 1998, January 1, 1999 and April 1, 1999; the MDS 2.0 Transition Payments for FY 1998-1999; and the reconciliation of interim rates for FY 1998-1999.
Proposed rate notices and information concerning the MDS 2.0 Transition Payments and interim rates were published at 29 Pa.B. 1444 (March 13, 1999), 29 Pa.B. 1445 (March 13, 1999) and 29 Pa.B. 1790 (April 3, 1999).
The Department of Public Welfare (Department) is publishing this notice in accordance with 42 U.S.C.A. § 1902(a)(13)(A), as amended by section 4711 of the Balanced Budget Act of 1997 (P. L. 105-33) and 42 C.F.R. 447.205.
Rates and Payments
The final rates for July 1, 1998, October 1, 1998, January 1, 1999 and April 1, 1999, and information concerning the MDS 2.0 Transition Payments and interim rates are available through the Bulletin Board System (BBS) at (800) 833-5091, at the local County Assistance Offices throughout this Commonwealth, or by contacting Tom Jayson in the Policy Section of the Bureau of Long Term Care Programs at (717) 772-2570.
The methodology that the Department used to set the final rates is contained in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting) and the Commonwealth's approved Title XIX State Plan. The methodology for the MDS 2.0 Transition Payments is contained in the Commonwealth's approved Title XIX State Plan.
The regulations at 55 Pa. Code Chapter 1187 and/or the Commonwealth's approved Title XIX State Plan require the establishment of final rates and the MDS 2.0 Transition Payments.
In April 1999, the Department announced its intention to revise payment rates and make MDS 2.0 Transition Payments for Medical Assistance (MA) nursing facility services based on comments received concerning earlier notices and ongoing discussions with the nursing facility trade associations. (See 29 Pa.B. 1790 (April 3, 1999)). The Department also established interim rates by which it would pay for MA nursing facility services pending the issuance of final rates and MDS 2.0 Transition Payments for FY 1998-99.
The comments received concerning the payment rates and the discussions with the nursing facility trade associations focused on the Department's use of quarterly assessment data to calculate case-mix indices (CMIs) for price and rate-setting purposes. As a result of these discussions, the Department decided to recalculate nursing facility CMIs for picture dates commencing February 1998 using only resident data reported for admission, annual and significant change assessments. The final rates announced by this notice are based on the recalculated MA CMIs.
As also announced in the April 3, 1999 notice, the Department submitted a State Plan Amendment regarding the MDS 2.0 Transition Payments. (See 29 Pa.B. 1790). As indicated in that notice, the purpose of the MDS 2.0 Transition Payments is to minimize any negative impact the MDS 2.0 assessment instrument may have on nursing facility payment rates for the FY 1998-99. On June 30, 1999, the Department received approval of the State Plan Amendment relating to MDS 2.0 Transition Payments. Nursing facility providers and other interested parties may refer to the notice at 29 Pa.B. 1790 (April 3, 1999) for a detailed description of the MDS 2.0 Transition Payments.
The April 3, 1999 notice also announced the Department's intentions with regard to payments to nursing facility providers during the period between the announcement of proposed rates and the establishment of final rates for each quarter beginning July 1, 1998 through June 30, 1999. (See 29 Pa.B. 1790). Consistent with that notice, the Department will reconcile each facility's interim payments for FY 1998-99 based on its final rates and any MDS 2.0 Transition Payment to which a facility may be entitled as indicated in the April 3, 1999 notice (29 Pa.B. 1790).
The estimated increase in annual aggregate expenditures for Medical Assistance nursing facility services for FY 1998-1999, based on these final rates, is $48.433 million ($22.372 million in State funds).
Comments may be submitted to Tom Jayson, Policy Section, Department of Public Welfare, Division of Long Term Care Provider Services, P. O. Box 8025, Harrisburg, PA 17105. Persons with a disability may use the AT&T Relay Services by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). Persons who require another alternative should contact Thomas Vracarich in the Office of Legal Counsel at (717) 783-2209.
FEATHER O. HOUSTOUN,
Fiscal Note: 14-NOT-227. (1) General Fund; (2) Implementing Year 1999-00 is $22.372 Million; (3) 1st Succeeding Year 2000-01 is -0-; 2nd Succeeding Year 2001-02 is -0-; 3rd Succeeding Year 2002-03 is -0-; 4th Succeeding Year 2003-04 is -0-; 5th Succeeding Year 2004-05 is -0-; (4) 1998-99 Program--$721.631 Million; 1997-98 Program--$617.252 Million; 1996-97 Program --$591.910 Million; (7) Medical Assistance--Long Term Care; (8) recommends adoption. There are funds available in the Department's budget to cover this one time rate adjustment.
[Pa.B. Doc. No. 99-2014. Filed for public inspection November 24, 1999, 9:00 a.m.]
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