Managed Care Assessment Program for Fiscal Year 2017-2018
[46 Pa.B. 7904]
[Saturday, December 17, 2016]
The Department of Human Services (Department) is announcing a proposed adjustment to the managed care assessment fixed fee for Fiscal Year (FY) 2017-2018.
In 2015, the General Assembly enacted legislation authorizing the Department to impose an annual monetary assessment on managed care organizations (MCO) in the Commonwealth for a 4-year period beginning with State FY 2016-2017. See the act of December 28, 2015 (P.L. 500, No. 92) (Act 92). Act 92 sets the initial assessment fixed fee at $13.48 per member month,1 but also authorizes the Secretary of the Department to adjust the assessment fixed fee for all or part of a fiscal year so long as the assessment does not exceed the Federal maximum 6% limit under 42 CFR 433.68(f)(3)(i)(A) (relating to permissible health care-related taxes). Before adjusting the assessment percentage, the Secretary must publish a notice in the Pennsylvania Bulletin that specifies the proposed adjusted fixed fee and identifies the aggregate impact on covered MCO plans subject to the assessment and allow interested parties a 30-day period in which to comment. After consideration of any comments received during the 30-day period, the Secretary must publish a second notice announcing the adjusted fixed fee.
Proposed Adjusted Assessment Fixed Fee
The Department is proposing to adjust the MCO assessment fixed fee to $15.07 per member month effective July 1, 2017. The proposed adjusted MCO assessment fixed fee does not exceed the Federal maximum limit of 6% of revenue.
The Department estimates that the annual aggregate assessment fixed fees for MCOs in FY 2017-2018 will total $1,051.317 million.
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered in the determination of the final adjusted MCO assessment fixed fee. 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-1108. (1) General Fund; (2) Implementing Year 2016-17 is $0; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are -$1,051,000,000; (4) 2015-16 Program—$3,828,000,000; 2014-15 Program—$3,823,000,000; 2013-14 Program—$3,995,000,000; (7) Medical Assistance—Capitation; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 16-2209. Filed for public inspection December 16, 2016, 9:00 a.m.]
1 Individuals who are enrolled in Medicare Advantage plans and other Federally-funded health care plans are not considered members in determining an MCO's assessment amount. See 62 P.S. § 801-I (definitions). The assessment does not apply to self-funded health care plans.
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