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PA Bulletin, Doc. No. 08-1342


Payments to Nonpublic Nursing Facilities; Proposed Rates for State Fiscal Year 2008-2009

[38 Pa.B. 3943]
[Saturday, July 19, 2008]

Purpose of Notice

   This notice announces the Department of Public Welfare's (Department) proposed annual case-mix per diem payment rates for State Fiscal Year (FY) 2008-2009 for nonpublic nursing facilities that participate in the Medical Assistance (MA) Program.

   As required by the case-mix payment methodology set forth in Chapter 1187, Subchapter G (relating to rate setting), 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 2008-2009, 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 § 1187.96(e)(2)(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 2008-2009. The Department will be submitting State Plan Amendment (SPA) 08-007 to the Federal Centers for Medicare and Medicaid Services (CMS) to include the BAF formula which the Department will use in FY 2008-2009.

   Contingent on CMS approval of SPA 08-007 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

   Based on the funding provided in the Governor's executive budget and approval of SPA 08-007 by CMS, the Department has determined that the percentage rate of increase appropriated for nursing facility services for FY 2008-2009 is .90551.

   The proposed annual per diem rates for FY 2008-2009 are available on the web site for the Department of Public Welfare at and at local county assistance offices throughout this Commonwealth or by contacting Gail Weidman, Department of Public Welfare, Office of Long Term Living, at (717) 705-3705. In addition, the Department will calculate adjusted quarterly rates for the October, January and April quarters of FY 2008-2009 for each nonpublic MA nursing facility provider. These adjusted quarterly rates will be posted on the Department's web site, at local county assistance offices and from Gail Weidman, as they become available.

Fiscal Impact

   No fiscal impact is anticipated as a result of the proposed rates in FY 2008-2009.

Public Comment

   Interested persons are invited to submit written comments regarding the proposed annual rates for FY 2008-2009 or the BAF formula to 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 1-800-654-5984 (TDD users) or (800) 654-5988 (voice users).


   Fiscal Note: 14-NOT-556. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 08-1342. Filed for public inspection July 18, 2008, 9:00 a.m.]

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