Payment for Nursing Facility Services Provided by Special Rehabilitation Nursing Facilities; Change in Methods and Standards of Setting Payment Rates
[41 Pa.B. 5826]
[Saturday, October 29, 2011]
The Department of Public Welfare (Department) is considering amending its regulations and the Commonwealth's Title XIX State Plan to change its methods and standards for payment of Medical Assistance (MA) nursing facility services provided by Special Rehabilitation Nursing Facilities (SRF) beginning November 1, 2011.
Currently, the MA Program pays for nursing facility services provided to MA eligible recipients in SRFs at per diem rates that are computed using the case-mix payment system set forth in the Department's regulations in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting). The case-mix rates for SRFs are calculated using the same methodology as all other nonpublic nursing facilities except that, for the purposes of establishing peer group medians and prices, SRFs are classified in a Statewide peer group without regard to their size or geographic location.1 For a nursing facility to be classified in the SRF peer group, more than 70% of the nursing facility's residents must have a neurological/neuromus- cular diagnosis and severe functional limitations.2 When the case-mix system was implemented on January 1, 1996, three nursing facilities were approved as SRFs. A facility related to one of the original three was approved in 2000. Currently, there are eight SRFs.
This public notice supersedes the notice published at 40 Pa.B. 7441 (December 25, 2010), in which the Department announced it was considering changing its methods and standard for payment of MA nursing facility services provided by SRFs beginning January 1, 2011.
Peer Grouping for Price Setting
The Department is considering an amendment to the manner in which the peer group medians and peer group prices would be set for Peer Group (PG) 13. For this purpose, the Department would array the first four SRFs to set the peer group median and prices for those four facilities. The remaining four SRFs, and any subsequent facility designated as an SRF, would be arrayed with all other SRFs, including the first four SRFs to set their peer group median and prices. The effective date of this amendment would be November 1, 2011. The Department would continue using data from all existing and future nursing facilities classified as SRFs to establish PG13 peer group medians and peer group prices for the SRFs that are approved after July 1, 2000.
There is no fiscal impact for Fiscal Year 2011-2012.
Interested persons are invited to submit written comments regarding these proposed changes to the Department of Public Welfare, Office of Long-Term Living, Attention: Marilyn Yocum, Department of Public Welfare/Department of Aging, Office of Long-Term Living, Policy and Strategic Planning, 555 Walnut Street, Forum Place, 5th Floor, Harrisburg, PA 17101-1919. 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).
GARY D. ALEXANDER,
Fiscal Note: 14-NOT-724. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 11-1834. Filed for public inspection October 28, 2011, 9:00 a.m.]
1 Hospital-based nursing facilities are also classified in a state-wide peer group. See 55 Pa. Code § 1187.94 (relating to peer grouping for price setting).
2 See 55 Pa. Code § 1187.2 (relating to definitions).
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