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PA Bulletin, Doc. No. 13-1175


Payment for Nursing Facility Services Provided by County Nursing Facilities; Change in Methods and Standards of Setting Payment Rates; Pay for Performance

[43 Pa.B. 3585]
[Saturday, June 29, 2013]

 The Department of Public Welfare (Department) intends to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services for qualified county nursing facilities for Fiscal Year (FY) 2013-2014.


 For FY 2006-2007 through 2012-2013 the Department provided pay for performance incentive payments to qualified county nursing facilities. The qualifying criteria and formula used to determine those payments is in the Commonwealth's approved State Plan.

 The Department intends to continue the pay for performance incentive payments to qualifying county nursing facilities for FY 2013-2014. To qualify for these payments, a county nursing facility must be a county nursing facility at the time of payment and its MA case-mix index (CMI) for the picture date within the pay for performance payment period must be higher than its facility MA CMI for the previous picture date. To determine the payments, the Department will ascertain the total quarterly funds available for the performance incentive payments and divide that amount by the total MA days for all county nursing facilities meeting the qualifying criteria. The MA days used for each county nursing facility will be the paid MA days identified on the most recent PROMISe data file used to determine eligibility for disproportionate share payments.

 To authorize the continuation of the payments for FY 2013-2014 the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS).

 Contingent upon the approval by CMS of the SPA, the Department will continue pay for performance incentive payments to qualified county nursing facilities for FY 2013-2014. The payments will be made quarterly to qualified county nursing facilities according to the criteria and formula in the Commonwealth's approved State Plan.

Fiscal Impact

 The payments are estimated to cost the Department $6.500 million ($3.009 million in State funds) in FY 2013-2014.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, P. O. Box 8025, Harrisburg, PA 17106-8025. 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 Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

Acting Secretary

Fiscal Note: 14-NOT-827. (1) General Fund; (2) Implementing Year 2013-14 is $3,009,000; (3) 1st Succeeding Year 2014-15 is $0; 2nd Succeeding Year 2015-16 is $0; 3rd Succeeding Year 2016-17 is $0; 4th Succeeding Year 2017-18 is $0; 5th Succeeding Year 2018-19 is $0; (4) 2012-13 Program—$765,923,000; 2011-12 Program—$737,356,000; 2010-11 Program—$728,907,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 13-1175. Filed for public inspection June 28, 2013, 9:00 a.m.]

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