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PA Bulletin, Doc. No. 14-1931


Payment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Medical Assistance Day One Incentive Payments to Nonpublic Nursing Facilities for Fiscal Year 2014-2015

[44 Pa.B. 5938]
[Saturday, September 13, 2014]

 This announcement provides advance notice that the Department of Public Welfare (Department) intends to continue to make Medical Assistance Day One Incentive (MDOI) payments to qualified nonpublic nursing facilities for Fiscal Year (FY) 2014-2015. The MDOI payments to nonpublic nursing facilities will provide incentives to nonpublic nursing facilities to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission. The MDOI payments are intended to encourage nonpublic nursing facilities to increase access to care for the poor and indigent citizens of this Commonwealth.


 The act of July 9, 2013 (P. L. 369, No. 55), among other things, directed the Department to make quarterly MDOI payments for FY 2013-2014 to qualified nonpublic nursing facilities. The act of July 10, 2014 (P. L. 1053, No. 126) directs the Department to continue to make quarterly MDOI payments to qualified nonpublic nursing facilities for FY 2014-2015. The Department will use the Total Pennsylvania Medical Assistance (PA MA) days and Total Resident Days as reported by nonpublic nursing facilities under Article VIII-A of the Public Welfare Code (62 P. S. §§ 801-A—815-A), regarding nursing facility assessments, to determine eligibility and calculate payments.

 To qualify for MDOI payments, the nursing facility must be a nonpublic nursing facility for the full Resident Day quarter prior to the applicable quarterly reporting due dates of October 31, January 31, April 30 and July 31. In addition, the nonpublic nursing facility shall have an overall occupancy rate of at least 85% and an MA occupancy rate of at least 65% during the Resident Day quarter. A nursing facility's overall occupancy rate for these payments will be determined as follows: Overall occupancy rate = (Total Resident Days ÷ (licensed bed capacity at the end of the quarter x the number of calendar days in the quarter)). A nursing facility's MA occupancy rate for these payments will be determined as follows: MA occupancy rate = Total PA MA days ÷ Total Resident Days.

 Using the nursing facility assessment quarterly resident day reporting forms available on October 31, January 31, April 30 and July 31, the Department will calculate each qualified nonpublic nursing facility's MDOI quarterly payment based on the following formula:

 (i) The MDOI quarterly per diem will be 1/4 of the total funds appropriated for the rate year divided by the Total PA MA days as reported by all qualifying nonpublic nursing facilities.

 (ii) Each qualified nonpublic nursing facility's quarterly MDOI payment will be the quarterly per diem multiplied by a nonpublic nursing facility's Total PA MA days.

 The MDOI payments for each quarter of the rate year will be paid in the following quarter. The Department will not retroactively revise an MDOI payment amount based on a nursing facility's late submission or revision of its report related to the previously listed dates. The Department may recoup payments based on an audit of a nursing facility's report.

 The Department will submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS). If the CMS approves the SPA, the Department will have the authority to make MDOI payments to nonpublic nursing facilities for FY 2014-2015.

Fiscal Impact

 The fiscal impact of this change is estimated at $16.604 million ($8 million in State funds) for FY 2014-2015.

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 17105-8025. 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 Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-898. (1) General Fund; (2) Implementing Year 2014-15 is $8,000,000; (3) 1st Succeeding Year 2015-16 through 5th Succeeding Year 2019-20 are $0; (4) 2013-14 Program—$820,409,000; 2012-13 Program—$770,903,000; 2011-12 Program—$737,356,000; (7) MA—Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 14-1931. Filed for public inspection September 12, 2014, 9:00 a.m.]

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