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PA Bulletin, Doc. No. 04-1791

NOTICES

Payments to Nursing Facilities; Proposed Rates for State Fiscal Year 2003-2004

[34 Pa.B. 5317]

   This notice announces the Department of Public Welfare's (Department) intent to make changes in the payment rates for Medical Assistance (MA) nursing facility providers for the State Fiscal Year 2003-2004 (FY 03-04). The Department is proposing to make these changes because they are required by the case-mix rate-setting methodology in 55 Pa. Code Chapter 1187 (relating to nursing facility services) and the Commonwealth's approved Medicaid State Plan.

   Under the Department's case-mix payment methodology, the Department establishes a new case-mix per diem payment rate for each MA nursing facility provider once for each fiscal year. See 55 Pa. Code § 1187.95 (relating to general principles for rate and price setting). Each provider's annual case-mix per diem rate is comprised of four cost components: (i) resident care; (ii) other resident related; (iii) administrative; and (iv) capital. For each quarter of the fiscal year, the Department adjusts the resident care cost component of each provider's rate by multiplying the resident care cost component by the provider's MA Case-Mix Index for the appropriate picture date as follows: July 1 rate--February 1 picture date; October 1 rate--May 1 picture date; January 1 rate--August 1 picture date; and April 1 rate--November 1 picture date. See 55 Pa. Code § 1187.96 (relating to price and rate setting computations). The Department pays the provider for nursing facility services provided to MA recipients during that quarter using the provider's adjusted quarterly per diem rate.

   The Department has calculated new annual case-mix per diem payment rates for FY 03-04 for MA nursing facility providers. The Department is proposing to adopt and make payments to MA nursing facility providers using these rates. Before adopting these rates, the Department is making them available for public review and comment. The proposed FY 03-04 annual per diem rates are available on the Office of Medical Assistance Programs' (OMAP) website: www.dpw.state.pa.us/omap. The proposed FY 03-04 annual per diem rates are also available at local county assistance offices throughout this Commonwealth or by contacting Tom Jayson, Policy Unit, Bureau of Long Term Care Programs, (717) 705-3705.

   The Department has also calculated adjusted quarterly rates for the July, October, January and April quarters of FY 03-04 for each MA nursing facility provider. These adjusted quarterly rates are also available on the OMAP's website, at local county assistance offices and from Tom Jayson.

   The database that the Department used to calculate the rates is available on the OMAP's website. Since some of the audited cost reports in the database relate to fiscal periods beginning prior to January 1, 2001, the Department revised the audited costs in the database as specified in 55 Pa. Code § 1187.91(1)(iv)(D) (relating to database) to disregard certain audit adjustments disallowing minor movable property or linen costs. The criteria that the Department used to make these revisions are available on the OMAP's website or by contacting Tom Jayson.

Fiscal Impact

   The estimated increase in annual aggregate expenditures for MA nursing facility services for FY 03-04 is $142.5 million ($64.467 million in State funds).

Public Comment

   Interested persons are invited to submit written comments about the proposed rates to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin. Comments should be addressed to the Department of Public Welfare, Attn: Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. Persons with a disability may use the AT&T Relay Services, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-387. (1) General Fund; (2) Implementing Year 2003-04 is $64,467,000; (3) 1st Succeeding Year 2004-05 is $65,450,000; 2nd Succeeding Year 2005-06 is $65,450,000; 3rd Succeeding Year 2006-07 is $65,450,000; 4th Succeeding Year 2007-08 is $65,450,000; 5th Succeeding Year 2008-09 is $65,450,000; (4) 2002-03 Program--$777,084,000; 2001-02 Program--$761,877,000; 2000-01 Program--$722,565,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. Funding for 2003-04 is included in Act 9-A of 2003. Funding for 2004-05 is included in Act 7-A of 2004.

[Pa.B. Doc. No. 04-1791. Filed for public inspection September 24, 2004, 9:00 a.m.]


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