Payment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Medical Assistance Day One Incentive Payments to Nonpublic Nursing Facilities for Fiscal Year 2016-2017
[46 Pa.B. 5959]
[Saturday, September 17, 2016]
This announcement provides advance notice that the Department of Human Services (Department) intends to continue to make Medical Assistance Day One Incentive (MDOI) payments to qualified nonpublic nursing facilities for Fiscal Year (FY) 2016-2017. The MDOI payments to nonpublic nursing facilities will provide incentives to nonpublic nursing facilities to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission. The MDOI payments are intended to encourage nonpublic nursing facilities to increase access to care for the poor and indigent citizens of this Commonwealth.
The Department has previously been directed to make MDOI payments for FY 2013-2014, FY 2014-2015 and FY 2015-2016 to qualified nonpublic nursing facilities. See the act of July 9, 2013 (P.L. 369, No. 55), the act of July 10, 2014 (P.L. 1053, No. 126) and the act of December 28, 2015 (P.L. 500, No. 92). The act of July 8, 2016 (P.L. 480, No. 76) also directs the Department to continue to make MDOI payments to qualified nonpublic nursing facilities for FY 2016-2017. The Department will use the Total Pennsylvania Medical Assistance (PA MA) days and Total Resident Days as reported by nonpublic nursing facilities under Article VIII-A of the Human Services Code (62 P.S. §§ 801-A—815-A), regarding nursing facility assessments, to determine eligibility and calculate payments.
To qualify for MDOI payments, the nursing facility must be a nonpublic nursing facility for the full Resident Day quarter prior to the applicable quarterly reporting due dates of October 31, January 31, April 30 and July 31. In addition, the nonpublic nursing facility shall have an overall occupancy rate of at least 85% and an MA occupancy rate of at least 65% during the Resident Day quarter. A nursing facility's overall occupancy rate for these payments will be determined as follows: Overall occupancy rate = (Total Resident Days ÷ (licensed bed capacity at the end of the quarter × the number of calendar days in the quarter)). A nursing facility's MA occupancy rate for these payments will be determined as follows: MA occupancy rate = Total PA MA days ÷ Total Resident Days.
Each nursing facility may qualify for a maximum of four MDOI payments. Using the nursing facility assessment quarterly resident day reporting forms available on October 31 for the first payment, January 31 for the second payment, April 30 for the third payment and July 31 for the fourth payment, the Department will calculate each qualified nonpublic nursing facility's MDOI payments based on the following formula:
(i) An MDOI per diem for each payment will be 1/4 of the total funds appropriated for the fiscal year divided by the Total PA MA days as reported by all qualifying nonpublic nursing facilities.
(ii) Each qualified nonpublic nursing facility's MDOI payment will be the per diem multiplied by a nonpublic nursing facility's Total PA MA days.
The Department will not retroactively revise an MDOI payment amount based on a nursing facility's late submission or revision of its report related to the previously listed dates. The Department may recoup payments based on an audit of a nursing facility's report.
The Department will submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS). If CMS approves the SPA, the Department will have the authority to make MDOI payments to nonpublic nursing facilities for FY 2016-2017.
The fiscal impact of this change is estimated at $12.443 million ($6.000 million in State funds) for FY 2016-2017 and $4.148 million ($2.000 million in State funds) for FY 2017-2018.
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-1055. (1) General Fund; (2) Implementing Year 2016-17 is $6,000,000; (3) 1st Succeeding Year 2017-18 is $2,000,000; 2nd Succeeding Year 2018-19 through 5th Succeeding Year 2021-22 are $0; (4) 2015-16 Program—$968,083,000; 2014-15 Program—$810,545,000; 2013-14 Program—$820,409,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 16-1612. Filed for public inspection September 16, 2016, 9:00 a.m.]
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