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PA Bulletin, Doc. No. 23-1374



Payment for Nursing Facility Services; Public and Nonpublic Nursing Facility Medical Assistance One-Time Enhanced Supplemental Payment

[53 Pa.B. 6312]
[Saturday, October 7, 2023]

 The Department of Human Services (Department) intends to offer a one-time enhanced supplemental payment (2023 ES Payment) to eligible public and nonpublic Medical Assistance (MA) nursing facilities.

Specific Requirements

 The Department is the single State agency responsible for the administration of the MA Program. The Department reimburses public and nonpublic MA nursing facilities for the services they render to MA recipients through a combination of per diem rate payments, which are computed under the case-mix payment methodology in 55 Pa. Code Chapter 1187 (relating to nursing facility services), 55 Pa. Code Chapter 1189 (relating to county nursing facility services) and various supplemental payments, which are authorized in Chapters 1187, 1189 and the Commonwealth's approved Title XIX State Plan.

 Consistent with its focus on ensuring the sustainability of quality MA long-term living services to the consumers of those services, the Department intends to submit a State Plan Amendment (SPA) to the Federal Centers for Medicare & Medicaid Services (CMS) to authorize a 2023 ES Payment to public and nonpublic MA nursing facilities that meet specified criteria and agree to certain conditions. Under the proposed SPA, the Department would provide eligible public and nonpublic nursing facilities enrolled in and certified for participation in the MA Program, enhanced funding as part of the Department's ongoing efforts to address the economic impact of the novel coronavirus disease of 2019 (COVID-19).

 If CMS approves the SPA, the Department will make the 2023 ES Payment to qualified nursing facilities. To be eligible for a 2023 ES Payment, a nursing facility must satisfy all of the following conditions:

 1. The facility's NIS Provider ID must be on the following list as Exhibit A in the approved CMS SPA.

 2. The facility must satisfy the definition of either nursing facility or county nursing facility as those definitions are set forth in 55 Pa. Code § 1187.2 (relating to definitions) and in 55 Pa. Code § 1189.2 (relating to definitions).

 3. The facility must have been enrolled in and certified for participation in the MA program between January 1, 2020, and June 30, 2020.

 4. The facility must have submitted a Resident Day Reporting Form for at least one of the following Resident Day Quarters: Q 56; Q 57; Q 58; or Q 59.

 5. The facility must have paid assessment fees for the Fiscal Year (FY) 2019-2020 Nursing Facility Assessment Program.

 Payment of the 2023 ES Payment to qualified nursing facilities is contingent upon approval by CMS of the SPA, the qualified nursing facility being enrolled in and certified for participation in the MA Program on the date the Department pays the 2023 ES Payment and the facilities' signed release form and agreement accepting the terms and conditions for receipt of the 2023 ES Payment.

Fiscal Impact

 The fiscal impact of this announcement for FY 2022-2023 is estimated at $40 million ($18.352 million in State funds) for FY 2023-2024.

Public Comment

 Interested persons are invited to submit written comments regarding the 2023 ES Payment to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Robyn Kokus, P.O. Box 8025, Harrisburg, PA 17105-8025 or at 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 Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-1593. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2023-24 is $18,352,000; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $0; (4) 2022-23 Program—$131,981,000; 2021-22 Program—$121,346,000; 2020-21 Program—$208,841,000; (7) MA—Long-Term Living; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 23-1374. Filed for public inspection October 6, 2023, 9:00 a.m.]

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