Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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55 Pa. Code § 1151.34. Changes of ownership or control.

§ 1151.34. Changes of ownership or control.

 (a)  An inpatient psychiatric facility is not entitled to additional reimbursement due solely to change of ownership or control.

 (b)  If ownership changes, the Department will establish per diem payment rates as follows:

   (1)  If the change involves only one inpatient psychiatric facility, the Department will use the per diem payment rate assigned to the inpatient psychiatric facility before the change.

   (2)  If the change combines two or more inpatient psychiatric facilities into a single entity, such as a merger or consolidation, the Department will establish a new per diem payment rate for the new entity by averaging the rates of the previous entities on a days-weighted basis. To determine that days-weighted average, the Department will use the MA days of each previously enrolled inpatient psychiatric facility as reported in the most recent fiscal year for which all the previous entities filed acceptable Cost Reports (MA 336).

   (3)  If the change divides one enrolled inpatient psychiatric facility into two or more entities, the Department will use the per diem payment rate assigned to the inpatient psychiatric facility before the change, for all resulting entities.

   (4)  The Department will not rebase rates established under this subsection until it rebases rates Statewide.

   (5)  If the Department rebases rates Statewide after a change in ownership has occurred, by using a base year which predates or corresponds to the year of the change, the Department will use the Cost Reports (MA 336) and the claims data for the base year regardless of who owned the entity in that base year.

 (c)  If ownership changes, disproportionate share payment policy is as follows:

   (1)  If the change involves only one inpatient psychiatric facility, the Department will use the disproportionate share status assigned to the inpatient psychiatric facility before the change, so long as the inpatient psychiatric facility maintains the nonemergency obstetric services by which it previously complied with section 1923(d) of the Social Security Act (42 U.S.C.A. §  1396r-4(d)).

   (2)  If the change combines two or more inpatient psychiatric facilities into a single entity, such as a merger or consolidation, the Department will establish the new entity as eligible for disproportionate share payments if one or more of the previous entities was eligible for disproportionate share payments, so long as the resulting entity maintains the nonemergency obstetric services by which one of the previous entities complied with section 1923(d) of the Social Security Act. To determine the monthly disproportionate share payment for the new entity, the Department will add the monthly disproportionate share payments of the previous entities.

   (3)  If the change divides one enrolled inpatient psychiatric facility into two or more entities, the Department will use the disproportionate share status assigned to the inpatient psychiatric facility before the change, as long as each of the resulting entities maintains the nonemergency obstetric services by which the previous entity complied with section 1923(d) of the Social Security Act. The Department will pro rate the monthly disproportionate share payment of the previous entity on the basis of ratio of utilization agreed upon by the entities.

   (4)  The Department will not recalculate disproportionate share status established under this subsection until it recalculates disproportionate share status Statewide.

   (5)  If the Department makes a Statewide redetermination of disproportionate share status after a change of ownership has occurred, and uses a base year which predates or corresponds to the year of the change, the Department will use the cost reports for the base year regardless of who owned the entity in that base year.

   (6)  For a Statewide redetermination of disproportionate share status, the determination of disproportionate share status for the entities resulting from a division will be made on the basis of ratio of utilization for the base year as agreed upon by the entities.

 (d)  A hospital that changes ownership or closes shall submit final Cost Reports (MA 336) to the Department within 45 days of the change of ownership or closure.

 (e)  This section applies only to inpatient psychiatric facilities which change ownership in the period July 1, 1993, through June 30, 1995.

Authority

   The provisions of this §  1151.34 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. § §  201 and 443.1(1)).

Source

   The provisions of this §  1151.34 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2976; amended June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial pages (181772) to (181775).

Cross References

   This section cited in 55 Pa. Code §  1151.46 (relating to payment rate calculations for Fiscal Year 1993-94 and 1994-95).



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