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PA Bulletin, Doc. No. 99-625



Office of Medical Assistance Programs; Payments to Nursing Facilities

[29 Pa.B. 2086]

   The purpose of this announcement is to provide advance notice under 42 CFR 447.205 that the Department of Public Welfare (Department) intends to make changes in its methods and standards for setting payment rates for nursing facilities to authorize capital component payments for existing post-moratorium beds in a facility. The Department also intends to clarify the circumstances under which it has permitted capital component payments to nursing facilities that were granted waivers under prior regulations.

   Under the proposed new policy, the Department will have discretion to make capital component payments if: a) an equal or greater number of pre-moratorium beds currently receiving capital component payments are simultaneously closed and decertified; b) an entire licensed and medical assistance (MA) certified nursing facility is closed and decertified; c) the existing post-moratorium beds that will become eligible for capital component payments will draw residents from the same service area as the beds to be closed; d) any residents that are displaced by the closure of an entire facility are transferred to the facility that will receive the capital cost reimbursement waiver unless the resident requests transfer to another facility that is able to meet the individual's needs; e) the MA Program will experience an overall cost savings; and f) the proposal is otherwise in the best interests of the Department.

   The primary purpose of this proposed change is to reduce MA nursing facilities and beds in areas of this Commonwealth where an MA need for those beds does not exist. Such a reduction will serve the dual purpose of reducing the cost to the MA Program and encouraging the growth of home and community-based services available to MA recipients. Although the Department is unable to accurately predict the number of MA nursing facility beds that will be taken out of service as a result of this policy, the Department estimates that the annual aggregate decrease in MA expenditures will be approximately $24,246 for each bed taken out of service.

   A draft Statement of Policy authorizing capital component payments is available for review through the Bulletin Board System (BBS) at (800) 833-5091, at the local County Assistance Offices throughout the Commonwealth, or by contacting Connie Pretz in the Long Term Care Policy Section at (717) 772-2570. The Department invites interested persons to submit written comments about the Statement of Policy to the Department within 30 days. Comments should be addressed to: Department of Public Welfare, Office of Medical Assistance Programs, Attention: Policy Section, P. O. Box 8025, Harrisburg, PA 17105.

   The Department will also discuss and solicit input on the proposed change in payment methods and standards at meetings that will be held in Room 327, Health and Welfare Building, Harrisburg, at the Long Term Care Subcommittee of the Medical Assistance Advisory Committee (MAAC) on April 14, 1999 at 10:30 a.m.; the Consumer Subcommittee of the MAAC on April 21, 1999 at 1 p.m.; and the MAAC meeting on April 22, 1999 at 10 a.m. These meetings are open to the public.

   Following review and consideration of any comments received during this public review process, the Department intends to publish a final statement of policy in the Pennsylvania Bulletin announcing the final criteria for authorizing these capital component payments and to submit a State Plan Amendment incorporating the final criteria into the Commonwealth's approved Medicaid State Plan. Payment under these proposed changes are conditioned upon the publication of the statement of policy and the Health Care Financing Administration's approval of the State Plan Amendment.

   Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (Voice Users). If another alternative is required, please contact Thomas Vracarich in the Office of Legal Counsel at (717) 783-2209.


   Fiscal Note:  14-NOT-199. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 99-625. Filed for public inspection April 16, 1999, 9:00 a.m.]

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