Medical Assistance Dependency Payment for High Volume Special Rehabilitation Facilities
[49 Pa.B. 5764]
[Saturday, October 5, 2019]
The Department of Human Services (Department) provides advance notice that the Department intends to make a supplemental payment in Fiscal Year (FY) 2019-2020 to certain special rehabilitation facilities (SRF) with high Medical Assistance (MA) beneficiary and total facility occupancy levels.
SRFs specialize in providing care and services to adults who have a neurological/neuromuscular diagnosis and severe functional limitations. See 55 Pa. Code § 1187.2 (relating to definitions). Because of the complex needs of their residents, SRFs generally incur staffing and specialized medical equipment costs that are much higher than the costs of other MA nursing facility providers. Further, SRFs with high MA beneficiary and total facility occupancy levels are particularly dependent on MA payments to ensure continued operations. This is particularly the case for SRFs that care for a large number of MA beneficiaries. To help offset the higher costs incurred by these high-volume, high-MA beneficiary occupancy SRFs while those SRFs reconfigure to home and community-based services, the Department intends to make a supplemental payment to these facilities to assure that the unique services they provide continue to be available to MA beneficiaries.
The determination of whether a nursing facility qualifies for a MA dependency payment and the nursing facility's payment amount is based on the nursing facility's 12-month MA cost report with a reporting period ending either December 31, 2014, or June 30, 2015, and accepted on or before April 1, 2016. To qualify for a MA dependency payment a nursing facility must meet the following requirements:
1) Be classified as an SRF as of the cost report end date.
2) Have MA beneficiary occupancy greater than or equal to 94% as reported on Schedule A, Column A, Line 5 of the cost report.
3) Have an overall nursing facility occupancy greater than or equal to 95% as reported on Schedule A, Column A, Line 4 of the cost report.
4) Have at least 200 MA certified nursing facility beds as of the cost report end date.
The Department will calculate the MA dependency payment for FY 2019-2020 by multiplying the supplementation per diem by the number of paid MA facility and therapeutic leave days for the prior fiscal year. The supplementation per diem will be calculated by dividing the total funds available by the total number of paid MA facility and therapeutic leave days for the prior fiscal year.
The Department will submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS). If CMS approves the SPA, the Department will have the authority to make the supplemental payments to nonpublic nursing facilities for FY 2019-2020.
The fiscal impact of this change is estimated at $1.000 million ($0.478 million in State funds) for FY 2019-2020.
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 Development and Communications 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).
TERESA D. MILLER,
Fiscal Note: 14-NOT-1356. (1) General Fund; (2) Implementing Year 2019-20 is $478,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$850,149,000; 2017-18 Program—$1,099,000,000; 2016-17 Program—$1,082,000,000; (7) Long Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 19-1483. Filed for public inspection October 4, 2019, 9:00 a.m.]
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