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PA Bulletin, Doc. No. 16-1091


Payment for Nursing Facility Services; Nonpublic Nursing Facility Supplemental Payment and County Nursing Facility Medical Assistance Day One Incentive Payment for Fiscal Year 2016-2017

[46 Pa.B. 3353]
[Saturday, June 25, 2016]

 The Department of Human Services (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) 2016-2017.


 Article VIII-A of the Human Services Code (code) (62 P.S. §§ 801-A—815-A) authorizes the Department to impose an annual monetary assessment on nonpublic and county nursing facilities in this Commonwealth each fiscal year.1 Under Article VIII-A of the code, the Department may impose the assessment only to the extent that the assessment revenues qualify as the State share of MA Program expenditures eligible for Federal financial participation (FFP). See 62 P.S. § 803-A. To ensure receipt of FFP, Article VIII-A of the code requires the Department to seek a waiver from the Centers for Medicare & Medicaid Services (CMS) if necessary to implement the Assessment Program. See 62 P.S. § 812-A. For FY 2016-2017, the Department will submit a request to CMS for the continuation and an amendment to the Assessment Program.

 The Commonwealth budget for MA long-term care services for FY 2016-2017 estimates that $506.472 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).

 For nonpublic nursing facilities, in addition to reimbursing the MA allowable assessment cost, the Department intends to use a portion of the assessment revenue to continue the supplemental payments as described in the Department's currently approved State Plan. To receive the allowable assessment cost add-on and the supplemental payments, qualified nursing facilities must be located in a geographic zone where Community Health Choices (CHC) does not operate during the entire corresponding assessment quarter. To authorize the continuation of these supplemental payments beginning July 1, 2016, the Department will submit a State Plan Amendment (SPA) to CMS.

 For county nursing facilities, a portion of the revenue generated by the assessment will be used to fund the county nursing facility MA Day One Incentive (MDOI) Payments provided for in the Department's currently approved State Plan. MDOI Payments will be determined quarterly beginning FY 2016-2017, instead of an annual determination paid in quarterly installments. In addition, a county nursing facility will not qualify for a quarterly payment if they are located in a geographic zone where CHC operates during the entire quarter for which the payment is being made. To authorize the continuation of these MDOI Payments beginning July 1, 2016, the Department will submit a SPA to CMS.

 If CMS approves the SPAs, the Department will have the authority to make the supplemental payments, including the allowable assessment cost add-on, to nonpublic nursing facilities and the MDOI Payments to county nursing facilities.

 The supplemental payments to nonpublic nursing facilities will enable those facilities to increase salaries of 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 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 2016-2017 fiscal impact for these supplemental payments is estimated at $661.768 million ($319.104 million in State funds).

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, P.O. Box 8025, Harrisburg, PA 17105-8025. 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-1037. (1) General Fund; (2) Implementing Year 2015-16 is $0; (3) 1st Succeeding Year 2016-17 is $319,104,000; 2nd Succeeding Year 2017-18 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$810,545,000; 2013-14 Program—$820,409,000; 2012-13 Program—$770,903,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 16-1091. Filed for public inspection June 24, 2016, 9:00 a.m.]


1  The assessment authorized under Article VIII-A expires June 30, 2016 (see 62 P.S. § 815-A). This notice assumes that the General Assembly will enact legislation to reauthorize the assessment, effective July 1, 2016.

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