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PA Bulletin, Doc. No. 12-1222


Payment for Nursing Facility Services; Nonpublic Nursing Facility Supplemental Payment and County Nursing Facility Medical Assistance Day One Incentive Payment

[42 Pa.B. 3821]
[Saturday, June 30, 2012]

 The Department of Public Welfare (Department) provides advance notice that the Department intends to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services beginning in Fiscal Year (FY) 2012-2013.


 Article VIII-A of the Public Welfare Code (code) (62 P. S. §§ 801-A—815-A) directed the Department to ''implement a monetary assessment'' on general licensed nursing facilities beginning July 1, 2003, and ending June 30, 2007 (Assessment Program). See sections 801-A and 815-A of the code. The General Assembly enacted the act of 2007 (P. L. 49, No. 16) (Act 16), which directed the Department to continue the Assessment Program beginning FY 2007-2008 through 2011-2012 and also provided the Department with the authority to include the county nursing facilities in the Assessment Program beginning July 1, 2007.

 The Commonwealth budget for MA long-term care services for FY 2012-2013 estimates that $455.077 million will be derived from revenue collected from the Assessment Program plus related Federal matching funds. A portion of the revenue generated from the assessment will enable the Department to continue to set payment rates for MA nursing facility services under the existing payment methodology in 55 Pa. Code Chapters 1187 and 1189 (relating to nursing facility services; and county nursing facility services). It is anticipated that legislation will be enacted to extend the assessment for FY 2012-2013.

 For nonpublic nursing facilities, in addition to reimbursing the MA allowable assessment cost, the Department intends to use a portion of the revenue to continue the supplemental payments as described in the Department's currently approved State Plan. To authorize the continuation of these payments beginning July 1, 2012, the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS).

 For county nursing facilities, a portion of the revenue generated by the assessment will be used to increase the funding level for the county nursing facility MA Day One Incentive Payments (MDOI) provided for in the Department's currently approved State Plan. To authorize the continuation of these payments beginning July 1, 2012, the Department will submit an SPA to CMS.

 The Department projects that the assessment revenues and associated Federal matching funds will increase aggregate payments to MA nursing facility providers.

 If CMS approves the SPA, the Department will have the authority to make the supplemental payments to nonpublic MA nursing facilities and the increased MDOI payments to county nursing facilities.

 The supplemental payments to nonpublic MA nursing facilities will enable those facilities to increase salaries to direct care staff to maintain and increase staffing levels at a time when it is difficult to attract and retain qualified staff. The supplemental payments will also provide the facilities with additional funds to meet other unanticipated costs that may not be reflected in the current database used to establish rates, such as increased liability insurance costs.

 The increased MDOI payments to county nursing facilities will provide incentives to county nursing facilities to admit individuals who are MA eligible on the day of admission. The MDOI payments are intended to assure that county nursing facilities continue to provide access to care for these individuals. These payments provide an incentive to county nursing facilities to continue to provide for the poor and indigent citizens of this Commonwealth.

Fiscal Impact

 The FY 2012-2013 fiscal impact for these supplemental payments is estimated at $597.812 million ($273.320 million in State funds).

Public Comment

 Interested persons are invited to submit written comments regarding these proposed changes to the Department of Public Welfare, Office of Long-Term Living, Attention: Yvette Sanchez-Roberts, Department of Public Welfare/Department of Aging, Office of Long-Term Living, Policy and Strategic Planning, 555 Walnut Street, Forum Place, 5th Floor, Harrisburg, PA 17101-1919. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-764. (1) General Fund; (2) Implementing Year 2012-13 is $273,320,000; (3) 1st Succeeding Year 2013-14 is $0; 2nd Succeeding Year 2014-15 is $0; 3rd Succeeding Year 2015-16 is $0; 4th Succeeding Year 2016-17 is $0; 5th Succeeding Year 2017-18 is $0; (4) 2011-12 Program—$737,356,000; 2010-11 Program—$728,907,000; 2009-10 Program—$540,266,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 12-1222. Filed for public inspection June 29, 2012, 9:00 a.m.]

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