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PA Bulletin, Doc. No. 08-2087

NOTICES

Payment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Change in Methods and Standards of Setting Payment Rates

[38 Pa.B. 6343]
[Saturday, November 15, 2008]

Purpose

   This notice announces updated proposed annual rates for Medical Assistance (MA) nonpublic nursing facilities for State Fiscal Year (FY) 2008-2009 and updated information regarding the budget adjustment factor (BAF) that the Department of Public Welfare (Department) will apply to MA nonpublic nursing facility payment rates for FY 2008-2009.

Background

   On July 19, 2008, the Department published a notice announcing its proposed annual rates for MA nonpublic nursing facilities for FY 2008-2009. See 38 Pa.B. 3943 (July 19, 2008). As explained in that notice, the Department determined the proposed rates in accordance with 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting). The Department also explained that will adjust each facility's CMI-adjusted quarterly rate by multiplying the rate by a BAF.

   After the Department had submitted the notice for publication in the Pennsylvania Bulletin, the Pennsylvania General Assembly enacted two laws that affect MA nursing facility payment rates and the BAF for FYs 2008-2009, 2009-2010 and 2010-2011: the act of July 4, 2008 (P.L. 31, No. 44) (Act 44); and the General Appropriation Act of 2008 (Act 38A). In response to the request of the trade associations, the Department is updating its proposed annual rates and BAF calculation.

Act 44

   Among other things, Act 44, amended section 443.1 of the Public Welfare Act. Act 44 directed the Department to:

   *  Calculate payments to nonpublic nursing facilities in accordance with the methodologies for establishing payment rates specified in the Department's regulations and approved State Plan in effect after June 30, 2007.

   *  Apply a BAF to nonpublic nursing facility payment rates for each fiscal year between July 1, 2008, and June 30, 2011, that limits the estimated aggregate increase in the Statewide day-weighted average payment rate for each fiscal year based upon funds appropriated by the General Appropriations Act.

   *  Continue to include the costs incurred by county nursing facilities in the rate-setting database used for the purpose of calculating nonpublic nursing facility payment rates.

Act 38A

   The funds appropriated by the General Appropriations Act of 2008 for nursing facility payment rates for FY 2008-2009 provide for a percentage rate of increase of 1%. Using the formula described as follows, the Department recalculated the BAF to be applied to nonpublic nursing facility payment rates for FY 2008-2009 based on this percentage rate of increase.

FY 2008-2009 BAF Formula for Nonpublic Nursing Facilities

   BAF = (nonpublic nursing facilities' share of total appropriated funds + estimated annual patient pay amount) divided by estimated acuity-adjusted annual payments.

   Using this formula the Department has determined that the BAF that will be applied to nonpublic nursing facility payment rates for FY 2008-2009 is .90891.

State Plan Amendments

   Two State Plan Amendments (SPA 08-007 and 08-015) were submitted to the Centers for Medicare and Medicaid Services (CMS) to amend the Commonwealth's Title XIX Plan. SPA 08-007 specifies the BAF the Department intends to apply to nonpublic nursing facility payment rates for FY 2008-2009. SPA 08-015 provides forcontinuing the inclusion of county nursing facility costs in the process of computing the peer group prices used to set per diem rates for nonpublic facilities for FY 2008-2009.

   Application of the BAF in FY 2008-2009 and continuing the inclusion of county nursing facility costs in the rate setting process for nonpublic nursing facilities is subject to Federal approval of the amendments to the Commonwealth's State Plan.

   The updated proposed annual per diem rates for FY 2008-2009 are available on the web site for the Department of Public Welfare at: www.dpw.state.pa.us/PartnersProviders/LongTermLiving/ and at local county assistance offices throughout the Commonwealth or by contacting Gail Weidman, Department of Public Welfare, Office of Long-Term Living, at (717) 705-3705. In addition, the Department will calculate adjusted quarterly rates for the October, January and April quarters of FY 2008-2009 for each nonpublic MA nursing facility provider.

   After the quarterly rates are finalized, they will be posted on the Department's web site, and be available at local county assistance offices or by contacting Gail Weidman.

Fiscal Impact

   These changes will result in an estimated cost of $32.302 million ($14.726 million in State funds) for nonpublic nursing facilities 2008-2009 compared to the final April 1, 2008, rates. Funding for these changes has been included in the MA Long-Term Care appropriation.

Public Comment

   Interested persons are invited to submit written comments regarding the BAF formula to the Department of Public Welfare, Office of Long Term Living, Attention: Gail Weidman, 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 Services at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-574. (1) General Fund; (2) Implementing Year 2008-09 is $14,726,000; (3) 1st Succeeding Year 2009-10 is $16,065,000; 2nd Succeeding Year 2010-11 is $16,065,000; 3rd Succeeding Year 2011-12 is $16,065,000; 4th Succeeding Year 2012-13 is $16,065,000; 5th Succeeding Year 2013-14 is $16,065,000; (4) 2007-08 Program--$762,585,000; 2006-07 Program--$695,279,000; 2005-06 Program--$817,890,000; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 08-2087. Filed for public inspection November 14, 2008, 9:00 a.m.]


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