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PA Bulletin, Doc. No. 02-1606

NOTICES

DEPARTMENT OF
PUBLIC WELFARE

Payments to Nursing Facilities; July 1, 2001 Final Rates

[32 Pa.B. 4535]

   The purpose of this notice is to announce final payment rates for nursing facilities beginning July 1, 2001, in accordance with section 1902(a)(13)(A) of the Social Security Act (42 U.S.C.A. § 1902(a)(13)(A)), as amended by section 4711 of the Balanced Budget Act of 1997 (Pub. L. No. 105-33). A 2001-2002 Proposed Rates Notice was published at 31 Pa.B. 4018 (July 21, 2001) and provided for a 30-day comment period. A 2001-2002 Revised Proposed Rate notice was published at 31 Pa.B. 6748 (December 8, 2001) and provided a 30-day comment period. The Department of Public Welfare (Department) received two comment letters on the proposed July 1, 2001, rate notice that were considered in the development of the final rates.

   The Department submitted a State Plan Amendment that was approved by the Centers for Medicare and Medicaid Services (CMS) on June 17, 2002, and changes the methods and standards for setting payment rates for nursing facility services relating to movable property.

Rates

   The final July 1, 2001, rates are available through the local County Assistance Offices throughout this Commonwealth or by contacting Tom Jayson in the Policy Section of the Bureau of Long Term Care Programs at (717) 705-3705. The final July 1, 2001, rates and the data used to compute the rates may be found on the Office of Medical Assistance Programs' website at www.dpw.state.pa.us/omap.

Methodology

   The methodology that the Department used to set the final rates is contained in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting) and the Commonwealth's approved Title XIX State Plan.

Justification

   The justification for establishing the final rates is that the regulations in 55 Pa. Code Chapter 1187 (relating to nursing facility services) and the Commonwealth's approved Title XIX State Plan require that rates be set on a quarterly basis.

Appeals

   A Medical Assistance nursing facility provider that has not submitted a signed Certification and Settlement Agreement for Year 7 (July 1, 2001--June 30, 2002) may file an administrative appeal if it believes that the Department made any errors, or the provider otherwise disagrees with its year 7 rates. A provider's appeal must be in writing, sent to the Department's Bureau of Hearings and Appeals, P. O. 2675, Harrisburg, PA 17102, and received by the Bureau of Hearings and Appeals within 30 days of the date of the Department's letter notifying the provider of its final rates. The filing of an appeal constitutes the exclusive way by which a provider can present the Department with a demand that a final rate be modified, reversed, rescinded, or otherwise altered, or with a demand that the Department increase the amount of reimbursement paid to the provider under that rate. If a provider chooses to appeal, the provider will be afforded the opportunity for a de novo hearing before the Bureau of Hearings and Appeals. The provider's rates may be changed as a result of the final adjudication of the appeal. Providers should refer to 55 Pa. Code § 1187.141 (relating to nursing facilitiy's right to appeal and to a hearing) for more detail regarding their appeal rights and the requirements related to their written appeals.

   The estimated increase in annual aggregate expenditures for Medical Assistance nursing facility services for FY 2001-2002 based on these final rates is $102.576 million ($46.783 million in State funds).

   Interested persons are invited to submit written comments about the final rates to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin. Comments should be addressed to: Department of Public Welfare, Office of Medical Assistance Programs, Attention: Suzanne Love, P. O. Box 2675, Harrisburg, PA 17105.

   Persons with a disability may use the AT&T Relay Services by calling (800) 654-5984 (TDD Users) or (800) 654-5988 (Voice Users).

FEATHER O. HOUSTOUN,   
Secretary

   Fiscal Note:  14-NOT-329. (1) General Fund; (2) Implementing Year 2001-02 is $46,783,000; (3) 1st Succeeding Year 2002-03 is $51,036,000; 2nd Succeeding Year 2003-04 is $51,036,000; 3rd Succeeding Year 2004-05 is $51,036,000; 4th Succeeding Year 2005-06 is $51,036,000; 5th Succeeding Year 2006-07 is $51,036,000; (4) 2000-01 Program--$722,565,000; 1999-00 Program--$693,625,000; 1998-99 Program--$721,631,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. Finding for these changes is included in the 2001-02 and 02-03 budgets.

[Pa.B. Doc. No. 02-1606. Filed for public inspection September 13, 2002, 9:00 a.m.]


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