Payments to Nonpublic and County Nursing Facilities; Proposed Rates for State Fiscal Year 2015-2016
[45 Pa.B. 3427]
[Saturday, June 27, 2015]
This notice announces the Department of Human Services (Department) proposed annual case-mix per diem payment rates for State Fiscal Year (FY) 2015-2016 for nonpublic and county nursing facilities that participate in the Medical Assistance (MA) Program.
Nonpublic Nursing Facility Per Diem Rates
As required by the case-mix payment methodology in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department intends to set an 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 2015-2016, the Department will adjust the resident care component of each facility's rate by multiplying the resident care component by the facility's MA case-mix index (CMI) for the appropriate picture date.
In addition, as required by section 443.1(7)(iv) of the Public Welfare Code (62 P. S. § 443.1(7)(iv)), regarding MA payments for institutional care, the Department intends to adjust each facility's CMI-adjusted quarterly rate by multiplying the rate by a budget adjustment factor (BAF). The Department will submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) to include the BAF formula which the Department will use in FY 2015-2016.
A detailed description of the BAF formula for FY 2015-2016 is in the Payment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Notice of Change in Methods and Standards of Setting Payment Rates; Budget Adjustment Factor notice published at 45 Pa.B. 3425 (June 27, 2015). The BAF will limit the estimated Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the average payment rate in effect for the fiscal year is limited to the amount permitted by the funds appropriated by the General Appropriations Act for the fiscal year.1
Finally, in calculating the proposed rates, the Department assumed that the General Appropriations Act of 2015 will include the level of funding in the Governor's Executive Budget and that CMS will approve the SPA including the BAF formula for nonpublic nursing facilities.
County Nursing Facility Per Diem Rates
As required by the rate methodology in 55 Pa. Code Chapter 1189, Subchapter D (relating to rate setting), the Department intends to set an annual MA per diem rate for each county nursing facility provider. As specified in 55 Pa. Code § 1189.91(b) (relating to per diem rates for county nursing facilities), for each rate year beginning on or after July 1, 2007, the per diem rate paid to a county nursing facility for a rate year will be the facility's prior rate year per diem multiplied by a BAF determined in accordance with the formula in the Commonwealth's approved State Plan. CMS approved SPA 13-021 on November 7, 2013, which includes the BAF formula theDepartment will use for county nursing facilities in FY 2015-2016. The formula is as follows: BAF = 1.00 + the percentage rate of change permitted by the funds appropriated by the General Appropriations Act for the applicable rate year. In calculating the proposed rates, the Department assumed that the General Appropriation Act of 2015 will include the level of funding in the Governor's Executive Budget.2
The proposed annual per diem rates for FY 2015-2016, the facility-specific BAFs that will be applied to nonpublic nursing facility rates and the annual BAF that will be applied to county nursing facilities are available on the Department's web site at http://www.dhs.state.pa. us/provider/doingbusinesswithdhs/longtermcarecasemixinformation/index.htm and at local county assistance offices throughout this Commonwealth or by contacting Marilyn Yocum, Department of Human Services, Office of Long-Term Living at (717) 772-2549.
If the proposed payment rates are adopted as final, there is no fiscal impact for per diem rate payments for nonpublic and county nursing facilities' FY 2015-2016. The amount of funding available for this program is dependent upon the funds appropriated by the General Assembly in the forthcoming fiscal year. Therefore, until a budget bill is passed and enacted, any estimated fiscal impact associated with this notice is solely based on the funding levels as proposed in the Governor's Executive Budget.
Interested persons are invited to submit written comments regarding the proposed annual rates for FY 2015-2016 to the Department of Human Services, 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 the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
Fiscal Note: 14-NOT-963. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 15-1215. Filed for public inspection June 26, 2015, 9:00 a.m.]
1 The Department will finalize the BAF once the General Assembly has enacted a General Appropriations Act for FY 2015-2016 and will reference the nonpublic nursing facilities' base BAF and facility-specific base BAFs in its notice announcing final MA nursing facility payment rates for the rate-setting year.
2 The Department will finalize the BAF once the General Assembly has enacted a General Appropriations Act for FY 2015-2016 and will reference the county nursing facilities' annual BAF in its notice announcing final MA nursing facility payment rates for the rate-setting year.
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