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PA Bulletin, Doc. No. 08-1218


Payment for Nursing Facility Services; General Nursing Facility Supplemental Payment and County Nursing Facility MA Day One Incentive Payment

[38 Pa.B. 3560]
[Saturday, June 28, 2008]

   The purpose of this announcement is to provide advance notice that the Department of Public Welfare (Department) intends to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services beginning in Fiscal Year (FY) 2008-2009.


   Under the act of September 30, 2003 (P. L. 169, No. 25) (Act 25) directed the Department to ''implement a monetary assessment'' on nonpublic licensed nursing facilities beginning July 1, 2003, and ending June 30, 2007, (hereafter referred to as the ''Assessment Program''). See sections 801-A and 815-A of Act 25. The act of June 30, 2007 (P. L. 49, No. 16) (Act 16) directed the Department to continue the Assessment Program beginning FY 2007-2008 through 2011-2012 and also provided the Department with the authority to include the county nursing facilities in the Assessment Program beginning July 1, 2007. See sections 801-A, 802-A, 813-A and 815-A of Act 16.

   The Commonwealth budget for MA long-term care services for FY 2008-2009 estimates that $378.315 million will be derived from State revenue collected from the Assessment Program and related Federal matching funds. A portion of the revenue generated from the assessment will enable the Department to continue to set rates for MA nursing facility services under the payment methodologies contained in 55 Pa. Code Chapters 1187 and 1189 (relating to nursing facility services; and county nursing facility services) and the Commonwealth's State Plan.

   For general nursing facilities, in addition to reimbursing the MA allowable assessment cost, the Department intends to use a portion of the revenue to continue the supplemental payments as described in the Department's currently approved State Plan.

   For county nursing facilities, a portion of the revenue generated by the assessment will be used to increase the funding level for the county nursing facility MA Day One Incentive Payments (MDOI) provided for in the Department's currently approved State Plan. To authorize the increase in the funding level for the MDOI for FY 2008-2009, the Department will submit a State Plan amendment to CMS.

   If CMS approves the State Plan amendment for the increase in the MDOI payments, the Department will have the authority to pay the increased MDOI payments to county nursing facilities.

   The increased MDOI payments to county nursing facilities will provide incentives to county nursing facilities to admit individuals who are MA eligible on the day of admission. Nursing facilities are often reluctant to admit residents whose only source of coverage for nursing facility services is MA. County nursing facilities have traditionally acted as the safety net for those residents who have been denied admission to other nursing facilities. The MDOI payments are intended to assure that county nursing facilities continue to provide access to care for these individuals. These payments provide an incentive to county nursing facilities to continue to operate as safety net providers for the poor and indigent citizens of Pennsylvania.

Fiscal Impact

   As a result of this proposed policy change, the Department estimates that the annual aggregate assessment fees for nonexempt nursing facilities will total $378.315 million for FY 2008-2009. All of the revenue derived from the assessment fees and associated Federal matching funds will be used to make payments to qualified MA nursing facility providers in accordance with applicable law and regulations.

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Long-Term Living, 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 disability who require an auxiliary aid or service may submit comments using AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


   Fiscal Note:  14-NOT-558. No fiscal impact; (8) recommends adoption. The amount of $378,315,000 which includes both increased revenue and matching Federal funds is expected to be generated for Fiscal Years 2008-09, 2009-10, 2010-11 and 2011-12.

[Pa.B. Doc. No. 08-1218. Filed for public inspection June 27, 2008, 9:00 a.m.]

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