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PA Bulletin, Doc. No. 03-2464

NOTICES

DEPARTMENT OF
PUBLIC WELFARE

Payment for Nursing Facility Services; Change of the Definition of MA Day of Care

[33 Pa.B. 6468]

   The purpose of this announcement is to provide advance notice under 42 CFR 447.205 that the Department of Public Welfare (Department) intends to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services beginning fiscal year 2003-2004. More specifically, the Department intends to publish a proposed rulemaking which, if adopted, will amend 55 Pa. Code § 1187.2 (relating to definitions) by changing the definition of ''MA day of care.''

   The expansion of the HealthChoices Program and the expansion of the Long Term Care Capitated Assistance Program (LTCCAP) has increased the likelihood that an MA recipient who is admitted to a nursing facility will be enrolled in either a managed care organization (MCO) under contract with the Department or the LTCCAP. As a result, MCOs and LTCCAP providers will pay nursing facilities for a greater number of resident days of care.

   Neither an MCO or LTCCAP paid day of care qualifies as an MA day of care as the term is currently defined in 55 Pa. Code § 1187.2. The Department intends to propose amendments to the regulatory definition that would expand the definition of an MA day of care to include days of care for which an MCO under contract with the Department or LTCCAP provider pays 100% of the negotiated rate or fee for the MA resident's care in a nursing facility and days of care for which the resident and an MCO under contract with the Department or LTCCAP provider pays 100% of the negotiated rate or fee for the MA resident's care in the nursing facility. In addition, the Department intends to propose amendments that would further expand the definition of an ''MA day of care'' to include days of care for which the Department makes payment for MA residents receiving hospice services in a nursing facility.

   The Department will propose that this change in the definition of an ''MA day of care'' should take effect January 1, 2004, and should apply to disproportionate share incentive payments for fiscal periods ending on and after December 31, 2003, and to the MA case-mix index for picture dates beginning February 1, 2004.

Fiscal Impact

   If these proposed amendments to the definition of an ''MA day of care'' are adopted, the Department estimates that annual aggregate expenditures for MA nursing facility services for FY 2003-2004 will increase by $500,000 ($212,000 in State funds).

Public Comment

   A copy of this notice is available for review by contacting Gail Weidman, Long Term Care Policy Section, (717) 705-3705. Interested persons are invited to submit written comments regarding this notice to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin. Comments should be addressed to Department of Public Welfare, Division of Long-Term Care Client Services, Attn: Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105.

   Following review and consideration of any comments received in response to this notice, the Department intends to publish notice of proposed rulemaking in the Pennsylvania Bulletin announcing the proposed change in the definition of ''MA day of care.''

   Persons with a disability may use the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note:  14-NOT-376. (1) General Fund; (2) Implementing Year 2003-04 is $212,000; (3) 1st Succeeding Year 2004-05 is $237,000; 2nd Succeeding Year 2005-06 is $245,000; 3rd Succeeding Year 2006-07 is $252,000; 4th Succeeding Year 2007-08 is $260,000; 5th Succeeding Year 2008-09 is $268,000; (4) 2001-02 Program--$761,877,000; 2000-01 Program--$722,565,000; 1999-00 Program--$693,625,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. Funding for these changes has been provided through the Department's Intergovernmental Transfer Agreement for fiscal years 2003-04 and 2004-05.

[Pa.B. Doc. No. 03-2464. Filed for public inspection December 26, 2003, 9:00 a.m.]


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