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PA Bulletin, Doc. No. 04-2287

NOTICES

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

[34 Pa.B. 6788]

   The purpose of this notice is to announce the Department of Public Welfare's (Department) final payment rates for Medical Assistance (MA) nursing facility providers for the State Fiscal Year 2003-2004 (FY 03-04). The Department calculated the final payment rates in accordance with 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. A proposed rate notice for FY 03-04 was published at 34 Pa.B. 5317 (September 25, 2004) and provided for a 30-day comment period. The Department received one comment letter regarding the proposed State FY 03-04 notice. The Department considered the comment in the development of the final rates.

   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 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 will make payments to MA nursing facility providers using these rates. The final 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 final 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 $142.500 million ($64.467 million in State funds).

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department at the following address: Gail Weidman, Chief, Program Analysis and Review Section, Department of Public Welfare, P. O. Box 2675, Harrisburg, PA 17105. 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 AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-402. (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. 04-2287. Filed for public inspection December 23, 2004, 9:00 a.m.]


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