Managed Care Assessment Program
[49 Pa.B. 3412]
[Saturday, June 29, 2019]
The Department of Human Services (Department) is announcing a proposed adjustment to the managed care assessment fixed fee effective January 1, 2020.
In 2015, the General Assembly enacted legislation authorizing the Department to impose an annual monetary assessment on managed care organizations (MCO) in this Commonwealth for 4 years beginning in State Fiscal Year (FY) 2016-2017. See section 15 of the act of December 28, 2015 (P.L. 500, No. 92) (Act 92) (Article VIII-I of the Human Services Code (62 P.S. §§ 801-I—812-I)). The fixed fee assessed on MCOs is currently $19.87 per member per month.
Act 92 authorizes the Secretary of Human Services (Secretary) 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 of revenue specified in 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 assessment fixed fee, identifies the aggregate impact on MCOs subject to the assessment and affords interested parties 30 days to comment. After consideration of any comments received during the 30-day period, the Secretary must publish a second notice announcing the adjusted assessment fixed fee. See section 3-I(c) of the Human Services Code (62 P.S. § 803-I(c)).
Proposed Adjusted Assessment Fixed Fee
The Department is proposing to adjust the MCO assessment fixed fee to $24.95 per member per month effective January 1, 2020. The proposed adjusted assessment fixed fee will not exceed the Federal maximum limit of 6% of revenue.
The Department estimates that the aggregate fiscal impact for this change in FY 2019-2020 will be an additional $177.291 million in assessment revenue.
Interested persons are invited to submit written comments regarding the proposed adjustment to the MCO assessment fixed fee 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).
TERESA D. MILLER,
Fiscal Note: 14-NOT-1345. (1) General Fund;
(7) Medical Assistance—Capitation; (2) Implementing Year 2018-19 is $0; (3) 1st Succeeding Year 2019-20 is $172,290,000; 2nd Succeeding Year 2020-21 through 5th Succeeding Year 2023-24 are $344,581,000; (4) 2017-18 Program—$3,107,000,000; 2016-17 Program—$3,658,000,000; 2015-16 Program—$3,829,000,000;
(7) Medical Assistance—Community HealthChoices; (2) Implementing Year 2018-19 is $0; (3) 1st Succeeding Year 2019-20 is $4,066,000; 2nd Succeeding Year 2020-21 through 5th Succeeding Year 2023-24 are $8,131,000; (4) 2017-18 Program—$0; 2016-17 Program—$0; 2015-16 Program—$0;
(7) CHIP; (2) Implementing Year 2018-19 is $0; (3) 1st Succeeding Year 2019-20 is $935,000; 2nd Succeeding Year 2020-21 through 5th Succeeding Year 2023-24 are $1,870,000; (4) 2017-18 Program—$10,674,000; 2016-17 Program—$9,453,000; 2015-16 Program—$13,553,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase. The appropriations are able to absorb the increased cost.
[Pa.B. Doc. No. 19-977. Filed for public inspection June 28, 2019, 9:00 a.m.]
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