NOTICES
Payment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Notice of Change in Methods and Standards of Setting Payment Rates Purpose of Notice
[39 Pa.B. 4958]
[Saturday, August 15, 2009]The purpose of 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 provided by nonpublic nursing facilities in Fiscal Years (FY) 2009-2010 and 2010-2011.
Background
Act 2008-44 (Act 44) was enacted in Pennsylvania on July 4, 2008. Act 44 amended, among other things, provisions of the Public Welfare Code relating to payment for nursing facility services under the MA Program. More specifically, Act 44 directed the Department to extend the application of a budget adjustment factor (BAF) in calculating rates for MA nonpublic and county nursing facilities over a 3-year rate period beginning July 1, 2008, and ending June 30, 2011. Act 44 requires that the BAF shall limit the estimated aggregate increase in the Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the aggregate percentage rate of increase for the period that begins July 1, 2005, and ends on the last day of the FY is limited to the amount permitted by the funds appropriated by the General Appropriations Act for the FY.
For FYs 2009-2010 and 2010-2011, the Department intends to calculate the BAF for nonpublic nursing facilities as set forth as follows.
Nonpublic Nursing Facilities' BAF Determination.
Base BAF Formula
Prior to establishing the July rate for each rate year, the Department will use the following formula to determine the base BAF:
Target rate divided by the acuity-adjusted weighted average rate equals the base BAF.
April BAF Formula
Prior to establishing the April rate for each rate year, the Department will use the following formula to determine the April BAF:
The weighted average April rate will be compared to the April target rate. If the weighted average April rate is less than the April target rate and the difference is $.50 or more, the formula for the April BAF will be the April target rate divided by the weighted average April rate at 100%. Otherwise, the April BAF is equal to the base BAF.
Terms Related to the BAF Determination.
The following words and terms, when used in this notice; have the following meanings, unless the context clearly indicates otherwise:
Acuity-adjusted weighted average rate--The weighted average July rate at 100% adjusted by the acuity factor.
Acuity-factor--The percentage of change from the July rate to the October, January and April rates representing the estimated quarterly change in payments for the nonpublic nursing facilities. (See 55 Pa. Code § 1187.95(b) (relating to general principles for rate and price setting).)
April BAF--The BAF applied to each nonpublic nursing facility's April rate.
April target rate--The rate year's Statewide day-weighted average April rate needed to meet the rate year target rate.
Base BAF--The BAF applied to each nonpublic nursing facility's July, October and January rates.
Base days--The source of days for the day-weighted calculation used in determining the base rate, the weighted average April rate at 100% and the weighted average July rate at 100%. The base days are the sum of each nonpublic nursing facility's paid facility days, therapeutic leave days and 1/3 of the hospital bed reserve days from the PROMISe data file used to determine disproportionate share payments preceding the rate year used to determine the base rate.
Base rate--For FY 2009-2010, the Statewide day-weighted average April 2009 rate for nonpublic nursing facilities, calculated using base days. For FY 2010-2011, the base rate is the FY 2009-2010 target rate.
Target rate--The base rate multiplied by one plus the percentage rate of change permitted by the funds appropriated by the General Appropriations Act for the applicable rate year.
Weighted average April rate--The Statewide day-weighted average of the nonpublic nursing facilities' April rates for the applicable rate year determined in accordance with 55 Pa. Code Chapter 1187 (relating to nursing facility services), calculated using base days and the base BAF.
Weighted average April rate at 100%--The Statewide day-weighted average of the nonpublic nursing facilities' April rates for the applicable rate year determined in accordance with 55 Pa. Code Chapter 1187, calculated using base days, prior to application of a BAF.
Weighted average July rate at 100%--The Statewide day-weighted average of the nonpublic nursing facilities' July rates for the applicable rate year determined in accordance with 55 Pa. Code Chapter 1187 (relating to nursing facility services), calculated using base days prior to application of the base BAF.
To obtain authorization for these changes, the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS). Use of the calculations described above is contingent upon the approval by CMS of the SPA.
Fiscal Impact
No fiscal impact is anticipated as a result of these changes through June 30, 2011.
Public Comment
Interested persons are invited to submit written comments regarding the BAF formulas 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 the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-617. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 09-1477. Filed for public inspection August 14, 2009, 9:00 a.m.]
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