Payment for Nursing Facility Services Provided by County and Nonpublic Nursing Facilities; Notice of Change in Methods and Standards of Setting Payment Rates
[38 Pa.B. 3561]
[Saturday, June 28, 2008]
The purpose of this announcement is to provide advance notice that the Department of Public Welfare (Department) intends to change its methods and standards for payment of Medical Assistance (MA) nursing facility services for Fiscal Years (FY) 2008-2011 to authorize the continued use of a budget adjustment factor (BAF).
Proposed Change in Methods and Standards
Under the proposed State Plan Amendment, the Department will apply a BAF and make adjustments to county and nonpublic nursing facility payment rates in each fiscal year during the period of July 1, 2008, through June 30, 2011. The BAF for each fiscal year will limit the estimated Statewide day-weighted average payment rate for that fiscal year so that the aggregate increase in the Statewide day-weighted average payment rate over the period commencing July 1, 2005, and ending June 30 of the fiscal year in which the BAF is applied does not exceed the percentage rate of increase permitted by the funds appropriated for nursing facility services in the General Appropriations Acts for those fiscal years.
Once the Department determines the percentage rate of increase permitted by the General Appropriations Act for a fiscal year, the Department will use the following formula to determine the BAF which it will apply in setting rates for nonpublic nursing facilities:
* (nonpublic nursing facilities' share of total appropriated funds + estimated annual patient pay amount) divided by
* estimated acuity-adjusted annual payments.
The Department will use the following formula to determine the BAF which will apply in setting rates for county nursing facilities:
* BAF = 1.00 + the percent increase permitted by the General Appropriations Act.
If the General Assembly appropriates the level of funding set forth in the Governor's Proposed Budget for FY 2008-2009, the Department estimates that the Statewide day-weighted average payment rate over the 4-year period commencing July 1, 2005, and ending June 30, 2009, will increase in the aggregate by 10.12% from the Statewide day-weighted average payment rate for MA nursing facility services in FY 2004-2005. Based on this percentage rate of increase, the Department estimates that the BAF for nonpublic nursing facility payment rates will equal .90551 and the BAF for county nursing facility payment rates will equal 1.00.
For FY 2008-2009, a nonpublic nursing facility's case-mix per diem rate for an MA resident day will be the sum of the nursing facility's three net operating components and its capital rate component, multiplied by the nonpublic BAF. A county nursing facility's per diem rate for an MA resident will be the facility's July 1, 2007, per diem rate as calculated under Chapter 1189, Subchapter D (relating to rate setting) and § 1189.91(b) (relating to per diem rates for county nursing facilities) multiplied by the county BAF.
The Department will recalculate the BAF once the General Assembly has enacted a General Appropriations Act for FY 2008-2009 and will include the BAF in its notice announcing final MA nursing facility payment rates for the rate-setting year. For future rate years the Department will announce the BAF for nonpublic and county nursing facilities as part of the rate setting process.
No fiscal impact is anticipated as a result of these changes in FY 2008-2009.
Interested persons are invited to submit written comments regarding the BAF formula 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 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,
Fiscal Note: 14-NOT-555. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 08-1219. Filed for public inspection June 27, 2008, 9:00 a.m.]
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