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PA Bulletin, Doc. No. 04-578



Intergovernmental Transfer of Funds; Extension of County Nursing Facility Payments and Disproportionate Share Payments

[34 Pa.B. 1863]

   The purpose of this announcement is to provide advance notice under 42 CFR 447.205 (relating to public notice of changes in statewide methods and standards for setting payment rates) that during fiscal years (FYs) 2005-2009 the Department of Public Welfare (Department) intends to make changes in its payments to nursing facilities participating in the Medical Assistance (MA) Program.

   The Department previously published a notice at 31 Pa.B. 7076 (December 29, 2001) to extend the county transition payments for FYs 2003-2007 and the disproportionate share incentive to qualified nursing facilities for FYs 2003-2005.

   On October 16, 2002, and October 21, 2003, the Department entered into agreements with the County Commissioners Association of Pennsylvania that authorize the transfer of funds to the Commonwealth from several counties as authorized under 42 U.S.C.A. § 1396b(w)(6)(A) and 42 CFR 433.51(b) (relating to public funds as the state share of financial participation). The funds from these intergovernmental transfers (IGT) will be used as the State share for a portion of the county transition payments during FY 2007-2008 and FY 2008-2009, respectively, and for the disproportionate share incentive to qualified nursing facilities during FYs 2005-2007 and FY 2007-2008, respectively.

   The Department intends to revise its method for setting payment rates for county nursing facilities participating in the MA Program during FYs 2007-2009 to allow for county transition payments to be paid.

   The Department also intends to revise the disproportionate share incentive payments to qualified nursing facilities for FYs 2005-2008. The IGT agreement of October 16, 2002, states that for FYs 2005-2007, the disproportionate share per diem incentive shall be paid at two times the disproportionate share per diem incentive calculated in accordance with 55 Pa. Code § 1187.111(c) (relating to disproportionate share incentive payments). The IGT agreement of October 21, 2003, continues to double the disproportionate share per diem incentive through FY 2007-2008.

   These proposed changes in nursing facility payments during FYs 2005-2009 are contingent upon all of the following:  (1) approval by the Federal government of amendments to the Commonwealth's State Plan authorizing the county transition payments and the disproportionate share incentive payments; (2) the Commonwealth's receipt of IGTs of funds from county governments in amounts sufficient to make these payments; and (3) the promulgation of regulations to permit county transition payments during FYs 2007-2009 and double disproportionate share payments during FYs 2005-2008.

Fiscal Impact

   The estimated increase in annual aggregate expenditures during FYs 2005-2009 is $55.662 million in total funds ($25.469 million in State funds).

Public Comment

   Interested persons are invited to submit written comments to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin. Comments should be addressed to the Department of Public Welfare, Division of Long Term Care Client Services, Attention Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. Persons with a disability may use the AT&T Relay Services, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users) or the Department's TDD, (717) 787-3616.


   Fiscal Note:  14-NOT-381. (1) General Fund; (2) Implementing Year 2003-04 is $0; (3) 1st Succeeding Year 2004-05 is $0; 2nd Succeeding Year 2005-06 is $8,286,000; 3rd Succeeding Year 2006-07 is $8,534,000; 4th Succeeding Year 2007-08 is $8,649,000; 5th Succeeding Year 2008-09 is $0; (4) 2002-03 Program--$777,084,000; 2001-02 Program--$761,877,000; 2000-01 Program--$722,565,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. This regulatory action announces that the Department intends to make changes in its payments to nursing homes during fiscal years 2005-08 to allow for extension of county transition payments and the doubling of disproportionate share payments. Funding amounts previously listed will come from Intergovernmental Transfer (IGT) funds from county governments as part of an IGT final negotiated agreement.

[Pa.B. Doc. No. 04-578. Filed for public inspection April 2, 2004, 9:00 a.m.]

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