NOTICES
Payments to Nonpublic Nursing Facilities; Proposed Rates for State Fiscal Year 2006-2007
[36 Pa.B. 6474]
[Saturday, October 21, 2006]The Department of Public Welfare's (Department) annouces its proposed annual case-mix per diem payment rates for State Fiscal Year 2006-2007 (FY 06-07) for nonpublic nursing facilities that participate in the Medical Assistance (MA) Program.
As required by the case-mix payment methodology set forth in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), as amended at 36 Pa.B. 3207 (June 24, 2006), the Department intends to set a new annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate will have four components: resident care; other resident related; administrative; and capital. For each quarter of FY 06-07, the Department will adjust the resident care component of each facility's rate by multiplying the resident care cost component by the facility's MA case-mix index (CMI) for the appropriate picture date. In addition, the Department will adjust each facility's CMI-adjusted quarterly rate by multiplying the rate by a ''budget adjustment factor'' (BAF).
As required by 55 Pa. Code § 1187.96(d)(iv) (relating to price and rate setting computations), the Department intends to follow the formula set forth in the Commonwealth's approved State Plan to determine the BAF for FY 06-07. The Department recently submitted State Plan Amendments 06-008 and 06-009 to the Federal Centers for Medicare and Medicaid Services to include, among other things, the BAF formula which the Department will use in FY 06-07. As set forth in Supplement III to SPA 06-008, the Department completed these steps to determine the BAF:
Step 1: The Department determined the total appropriated funds that will be allocated for MA payments to nonpublic nursing facilities for the 2006-2007 rate year as follows:
1. Each county nursing facility's projected MA days for the rate year were multiplied by the facility's April 1, 2006, MA per diem rate to obtain each facility's projected payments for the rate year.
2. The projected payments for all county nursing facilities were added to obtain the total projected county payments for the rate year.
3. Each nonpublic nursing facility's projected MA days were multiplied by the facility's April 1, 2006, MA per diem rate to obtain each facility's projected payments for the rate year.
4. The projected payments for all nonpublic nursing facilities were added to obtain the total projected nonpublic payments for the rate year.
5. The total projected county and the total projected nonpublic payments were added to obtain the Statewide total projected payments for all nursing facilities for the rate year.
6. The total projected county payments were divided by the Statewide total projected payments to obtain the county projected payment percentage.
7. The county projected payment percentage was multiplied by the total funds appropriated in the General Appropriations Act for MA nursing facility services for the rate year to determine the total appropriated funds allocated to county nursing facilities.
8. The total appropriated funds allocated to county nursing facilities were subtracted from the total funds appropriated in the General Appropriations Act for MA nursing facility services for the rate year to determine the total appropriated funds allocated to nonpublic nursing facilities.
Step 2: The BAF for nonpublic nursing facilities was determined as follows:
1. The MA per diem rate for the first quarter of the rate year for each facility was calculated in accordance with § 1187.96(a)--(d) and (e)(1).
2. The first quarter rate for each nursing facility was multiplied by the facility's projected days to obtain the facility's nonacuity adjusted projected payments for the rate year.
3. The nonacuity adjusted projected payments for all nonpublic nursing facilities were added to obtain a Statewide nonpublic facility nonacuity adjusted payment total.
4. The Department estimated the Statewide total acuity adjustment percent by calculating the Statewide change in payments for nonpublic nursing facilities from payments at the first quarter rate level to payments at an average of the facility's four quarterly rates for each of the prior 4 rate years. The acuity adjustment percent for each of the prior 4 years was calculated by dividing the Statewide payments calculated using four quarterly rates by the payments calculated using the first quarter rate. The Statewide total acuity adjustment percent estimate for the current rate year is an average of the percents calculated for the prior 4 years.
5. The Department applied the Statewide total acuity adjustment percent estimate to the Statewide nonpublic facility nonacuity adjusted payment total to obtain the acuity-adjusted projected payment amount for all nonpublic nursing facilities for the current rate year.
6. The total appropriated funds allocated to nonpublic nursing facilities determined in Step 1-8 was added to the projected patient pay amount for nonpublic nursing facilities for the rate year and that amount was divided by the acuity-adjusted projected payment amount determined in Step 2-5 to determine the BAF to be used for each quarter of the rate year.
Using the BAF formula set forth in the pending State Plan Amendments, the budget adjustment factor for nonpublic nursing facilities for FY 06-07 will be .93755.
The proposed annual per diem rates for FY 06-07 are available on the website for the Office of Medical Assistance Programs (OMAP) at www.dpw.state.pa.us/omap and at local county assistance offices throughout thise Commonwealth or by contacting Tom Jayson, Policy Unit, Bureau of Long Term Living Support, at (717) 705-3705. In addition, the Department will calculate adjusted quarterly rates for the October, January and April quarters of FY 06-07 for each nonpublic MA nursing facility provider. These adjusted quarterly rates will be made available on the OMAP website, at local county assistance offices and from Tom Jayson.
Fiscal Impact
The change in payment rates, effective July 1, 2006, is estimated to cost the Department $103.782 million ($47.164 million in State funds) in FY 06-07.
Public Comment
Interested persons are invited to submit written comments regarding the proposed annual rates for FY 06-07 or the BAF formula to the Department at the following address: Department of Public Welfare, Bureau of Long- Term Living Support, Attention Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. 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 AT&T Relay Services at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-487. (1) General Fund; (2) Implementing Year 2006-07 is $47,164,000; (2) 1st Succeeding Year 2007-08 is $54,452,000; (3) 2nd Succeeding Year 2008-09 is $54,452,000; 3rd Succeeding Year 2009-10 is $54,452,000; 4th Succeeding Year 2010-11 is $54,452,000; 5th Succeeding Year 2011-12 is $54,452,000; (4) 2005-06 Program--$817,890,000; 2004-05 Program--$476,116,000; 2003-04 Program--$588,528,000; (7) Medical Assistance--Long-Term Care; (8) recommends adoption. Funds have been included in the current budget to cover the increase.
[Pa.B. Doc. No. 06-2072. Filed for public inspection October 20, 2006, 9:00 a.m.]
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