NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Payment for Nursing Facility Services Provided by County Nursing Facilities; Medicaid Day One Incentive Payments to County Nursing Facilities for Fiscal Years 2009-2010 and 2010-2011
[39 Pa.B. 3364]
[Saturday, July 4, 2009]Purpose
This announcement is to provide advance notice 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 for qualified county nursing facilities for Fiscal Years (FY) 2009-2010 and 2010-2011.
Background
On October 22, 2008, the Department entered into an agreement with the County Commissioners Association of Pennsylvania that authorizes the transfer of funds to the Commonwealth from several counties as authorized under 42 U.S.C.A. § 1396b(w)(6)(A) (relating to payment to States) and 42 CFR 433.51(b) (relating to funds from units of government as the State share of financial participation). Funds from the intergovernmental transfer (IGT) will be used as the State share for a portion of the Medicaid Day One Incentive Payments (MDOI) to qualified county nursing facilities during FYs 2009-2010 and 2010-2011.
For FYs 2006-2007 through 2008-2009 the Department provided MDOI payments to qualified county nursing facilities. The qualifying criteria and formula used to determine these payments, as set forth in the Commonwealth's approved State Plan, are:
To qualify for MDOI payments the nursing facility must be a county nursing facility both during the entire quarter for which the MDOI installment payment is being made and at the time the MDOI installment payment is made.
The Department will calculate each qualified county nursing facility's MDOI quarterly installment payment based on the following formula:
(i) The total funds allocated for the MDOI payments for the rate year will be divided by the total MA days for all county nursing facilities to determine the MDOI per diem for the rate year. The total MA days used for each county nursing facility will be the MA days identified on the most recent PROMISe data file used to determine the facility's eligibility for disproportionate share incentive payments.
(ii) The MDOI per diem for the rate year will be multiplied by each qualified county nursing facility's paid MA days identified on the most recent PROMISe data file used to determine eligibility for disproportionate share incentive payments, to determine its annual MDOI amount.
(iii) Each qualified county nursing facility's annual MDOI amount will be divided by four to determine the facility's MDOI quarterly installment payments for the rate year.
The MDOI installment payments for each quarter of the rate year will be paid in the first month of the following quarter.
In accordance with the IGT agreement of October 22, 2008, the MDOI payments for FYs 2009-2010 and 2010-2011 will continue to be made based on the formula in the Commonwealth's currently approved State Plan. In addition, for FY 2009-2010, the Department will use a portion of the revenues generated from the FY 2009-2010 Nursing Facility Assessment Program (The Act of June 30, 2007, P. L. 49 No. 16 (Act 16)) to increase the funding level for the county nursing facility MDOI.
To authorize the continuance of the MDOI payments for FYs 2009-2010 and 2010-2011, and the increase in the funding level for the MDOI payments for FY 2009-2010, the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS).
If CMS approves the SPA the Department will have the authority to continue to make MDOI payments to county nursing facilities for FYs 2009-2010 and 2010-2011, and increase the funding level for the MDOI for FY 2009-2010.
The MDOI payments to county nursing facilities will provide incentives to county nursing facilities to admit individuals who are MA eligible on the day of admission. Nursing facilities are often reluctant to admit residents whose only source of coverage for nursing facility services is MA. County nursing facilities have traditionally acted as the safety net for those residents who have been denied admission to other nursing facilities. The MDOI payments are intended to assure that county nursing facilities continue to provide access to care for these individuals. These payments provide an incentive to county nursing facilities to continue to operate as safety net providers for the poor and indigent citizens of Pennsylvania.
Fiscal Impact
The estimated increase in annual aggregate expenditures during FY 2009-2010 is $13.916 million in State funds and during FY 2010-2011 is $14.701 million in State funds.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Long-Term Living, Attention Tom Jayson, 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 Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-606. (1) General Fund; (2) Implementing Year 2009-10 is $13.916 M; (3) 1st Succeeding Year 2010-11 is $14.701 M; 2nd Succeeding Year 2011-12 is $0 M; 3rd Succeeding Year 2012-13 is $0 M; 4th Succeeding Year 2013-14 is $0 M; 5th Succeeding Year 2014-15 is $0 M; (4) 2007-08 Program--$692.585 M; 2006-07 Program--$695.279 M; 2005-06 Program--$817.890 M; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 09-1200. Filed for public inspection July 2, 2009, 9:00 a.m.]
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