Payments to Nonpublic and County Nursing Facilities; Proposed Rates for State Fiscal Year 2012-2013
[42 Pa.B. 3825]
[Saturday, June 30, 2012]
This notice announces the Department of Public Welfare's (Department) proposed annual case-mix per diem payment rates for State Fiscal Year (FY) 2012-2013 for nonpublic and county nursing facilities that participate in the Medical Assistance (MA) Program.
Nonpublic Nursing Facility Per Diem Rates
As required by the case-mix payment methodology regulations in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department intends to set an annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate will have four components: resident care; other resident related; administrative; and capital. For each quarter of FY 2012-2013, the Department will adjust the resident care component of each facility's rate by multiplying the resident care component by the facility's MA case-mix index for the appropriate picture date.
In calculating the proposed rates, the Department assumed that peer group prices for FY 2012-2013 will be set as specified in 55 Pa. Code § 1187.94(1)(v) (relating to peer grouping for price setting) which includes provisions that county nursing facility MA allowable costs have been phased-out of the rate-setting process for nonpublic nursing facilities. Further, for facilities classified as special rehabilitation facilities on or before July 1, 2000, peer group medians and prices will be established as described in the notice, Payment for Nursing Facility Services Provided by Special Rehabilitation Nursing Facilities; Change in Methods and Standards of Setting Payment Rates published at 41 Pa.B. 5826 (October 29, 2011).
Section 1187.96 of 55 Pa. Code (relating to price- and rate-setting computations) authorizes a 3-year phase-in period of the use of the Minimum Data Set Resource Utilization Group III version 5.12 44 Grouper (RUG v 5.12) and the most recent classifiable resident assessments beginning July 1, 2010, and ending June 30, 2013. The phase-in provisions only affect the resident care component of a facility's case-mix per diem rate. The resident care rate used to establish a nursing facility's case-mix per diem rate is a blended resident care rate which consists of a portion of the resident care rate calculated using the previous RUG version 5.01 Grouper (RUG v 5.01) and the most recent comprehensive resident assessments and a portion of the resident care rate calculated using RUG v 5.12 and the most recent classifiable resident assessments. For FY 2012-2013, the nursing facility's blended resident care rate will equal 25% of the nursing facility's RUG v 5.01 resident care rate from the prior rate quarter adjusted by the percent increase or decrease in the RUG v 5.12 resident care rate and 75% of the nursing facility's RUG v 5.12 resident care rate.
In addition, as required by section 443.1(7)(iv) of the Public Welfare Code, 62 P. S. § 443.1(7)(iv), regarding Medical Assistance payments for institutional care, the Department intends to adjust each facility's case-mix index-adjusted quarterly rate by multiplying the rate by a ''budget adjustment factor'' (BAF). The Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS) to include the BAF formula which the Department will use in FY 2012-2013.
A detailed description of the BAF formulas for FY 2012-2013 is in the notice Payment for Nursing Facility Services Provided by County and Nonpublic Nursing Facilities; Notice of Change in Methods and Standards of Setting Payment Rates published at 42 Pa.B. 3822 (June 30, 2012). The BAF will limit the estimated Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the average payment rate in effect for the fiscal year is limited to the amount permitted by the funds appropriated by the General Appropriations Act for the fiscal year.
Finally, in calculating the proposed rates, the Department assumed that the General Appropriations Act of 2012 will include the level of funding in the Governor's Executive Budget and that CMS will approve the SPA including the BAF formula for nonpublic nursing facilities.
County Nursing Facility Per Diem Rates
As required by the rate methodology in 55 Pa. Code Chapter 1189, Subchapter D (relating to rate setting), the Department intends to set an annual MA per diem rate for each county nursing facility provider. As specified in 55 Pa. Code § 1189.91(b) (relating to per diem rates for county nursing facilities), for each rate year beginning on or after July 1, 2007, the per diem rate paid to a county nursing facility for a rate year will be the facility's prior rate year per diem multiplied by a BAF determined in accordance with the formula in the Commonwealth's approved State Plan. In calculating the proposed rates, the Department assumed that CMS will approve the SPA including the BAF formula for county nursing facilities.
The proposed annual per diem rates for FY 2012-2013, the base BAF that will be applied to nonpublic nursing facility rates and the annual BAF that will be applied to county nursing facilities are available on the Department's web site at www.dpw.state.pa.us/provider/doingbusinesswithdpw/longtermcarecasemixinformation/index.htm and at local county assistance offices throughout this Commonwealth or by contacting Yvette Sanchez-Roberts, Department of Public Welfare, Office of Long-Term Living at (717) 705-3705. The proposed rates and BAFs were computed based upon the level of funding provided in the Governor's Budget.
If the proposed payment rates are adopted as final, the rates will result in an estimated decreased cost of $87.289 million ($39.736 million in State funds) for per diem rate payments to nonpublic nursing facilities and an estimated decreased cost of $20.024 million ($9.115 million in State funds) for per diem rate payments for county nursing facilities' FY 2012-2013 rates compared to the facilities' FY 2011-2012 per diem rates. The amount of funding available for this program is dependent upon the funds appropriated by the General Assembly in the forthcoming fiscal year. Therefore, until a budget is passed and enacted, any estimated fiscal impact associated with this notice is solely based on the funding levels as proposed in the Governor's Executive Budget.
Interested persons are invited to submit written comments regarding the proposed annual rates for FY 2012-2013 to Department of Public Welfare/Department of Aging, Office of Long-Term Living, Bureau of Policy and Strategic Planning, Forum Place, 5th Floor, 555 Walnut Street, Harrisburg, PA 17101-1919, Attention: Yvette Sanchez-Roberts. 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).
GARY D. ALEXANDER,
Fiscal Note: 14-NOT-765. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 12-1226. Filed for public inspection June 29, 2012, 9:00 a.m.]
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