NOTICES
Payments to Nonpublic and County Nursing Facilities; Final Rates for State Fiscal Year 2012-2013
[44 Pa.B. 3391]
[Saturday, June 7, 2014]This notice announces the Department of Public Welfare's (Department) final annual case-mix per diem payment rates for State Fiscal Year (FY) 2012-2013 for nonpublic and county nursing facilities that participate in the Medical Assistance (MA) Program.
Nonpublic Nursing Facility Per Diem Rates
As required by the case-mix payment methodology in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department annually sets an annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate is comprised of four components: resident care; other resident related; administrative; and capital. For each quarter of FY 2012-2013, the Department adjusted the resident care component of each facility's rate by multiplying the resident care component by the facility's MA case-mix index for the appropriate picture date.
In calculating the final rates, the peer group prices for FY 2012-2013 were set as specified in 55 Pa. Code § 1187.94(1)(v) (relating to peer grouping for price setting) which includes provisions that county nursing facility MA allowable costs have been phased-out of the rate-setting process for nonpublic nursing facilities. Further, for facilities classified as special rehabilitation facilities on or before July 1, 2000, peer group medians and prices were determined in accordance with the methodology described in the final-form rulemaking Payment for Nursing Facility Services Provided by Special Rehabilitation Nursing Facilities published at 44 Pa.B. 3322 (June 7, 2014). See § 1187.94(2)(i) and (ii).
In addition, 55 Pa. Code 1187.96 (relating to price- and rate-setting computations) authorized a 3-year phase-in period of the use of the Minimum Data Set Resource Utilization Group III version 5.12 44 Grouper (RUG v 5.12) and the most recent classifiable resident assessments beginning July 1, 2010, and ending June 30, 2013. The phase-in provisions only affect the resident care component of a facility's case-mix per diem rate. The resident care rate used to establish a nursing facility's case-mix per diem rate is a blended resident care rate which consists of a portion of the resident care rate calculated using the previous RUG version 5.01 Grouper (RUG v 5.01) and the most recent comprehensive resident assessments and a portion of the resident care rate calculated using RUG v 5.12 and the most recent classifiable resident assessments. For FY 2012-2013, the nursing facility's blended resident care rate equals 25% of the nursing facility's RUG v 5.01 resident care rate from the prior rate quarter adjusted by the percent increase or decrease in the RUG v 5.12 resident care rate and 75% of the nursing facility's RUG v 5.12 resident care rate.
The Federal Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 12-020 on November 23, 2012. SPA 12-020 states that the budget adjustment factor (BAF) will limit the estimated Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the average payment rate in effect for the fiscal year is limited to the amount permitted by the funds appropriated by the General Appropriations Act for the fiscal year. For FY 2012-2013, the Department calculated a base BAF for nonpublic nursing facility's for July, October and January rates and the base BAF was adjusted for the April-June 2013 calendar quarter. The formula the Department used to determine a base BAF equals the target rate divided by the acuity-adjusted weighted average rate. For the April BAF, the weighted average April rate was compared to the April target rate. Since the difference between the weighted average April rate and the April target rate was more than $0.50, a BAF for the April-June 2013 calendar quarter was determined by dividing the April target rate by the weighted average April rate at 100%. For the 2012-2013 rate year, the base BAF is 0.84559 and the April BAF is 0.85606.
County Nursing Facility Per Diem Rates
As required by the rate methodology in 55 Pa. Code Chapter 1189, Subchapter D (relating to rate setting), the Department annually sets an annual MA per diem rate for each county nursing facility provider. As stated in 55 Pa. Code § 1189.91(b) (relating to per diem rates for county nursing facilities), for each rate year beginning on or after July 1, 2007, the per diem rate paid to a county nursing facility for a rate year will be the facility's prior rate year per diem rate multiplied by a BAF.
In addition, as required by 55 Pa. Code § 1189.91(d), the Department followed the formula set forth in the Commonwealth's approved State Plan to determine that the BAF for FY 2012-2013 for county nursing facilities is 1.0. CMS approved SPA 12-019 on November 23, 2012.
SPA 12-019 states that for rate setting year 2012-2013, the BAF shall limit the estimated Statewide day-weighted average payment rate for medical assistance nursing facility services for county and nonpublic nursing facilities so that the average payment rate is limited to the amount permitted by the funds appropriated by the General Appropriations Acts. The BAF as it applies to county nursing facilities is 1.0.
The final annual per diem rates for FY 2012-2013 are available on the Department's web site at www.dpw.state.pa.us/provider/doingbusinesswithdpw/longtermcarecasemixinformation/index.htm and at local county assistance offices throughout this Commonwealth or by contacting Marilyn Yocum, Department of Public Welfare, Office of Long-Term Living at (717) 772-2549.
Public Process
The Department published a notice announcing its proposed case-mix per diem payment rates for nonpublic and county nursing facilities for FY 2012-2013 at 42 Pa.B. 3825 (June 30, 2012) and invited interested persons to submit comments. No comments were received by the Department in response to the proposed rate notice.
Appeals
Following publication of this notice, the Department will send rate letters to each MA nursing facility to notify the facilities of their final rates for FY 2012-2013. The rate letter will also advise each facility that it may file an administrative appeal if the facility believes that the Department made any errors or otherwise disagrees with its final rates for FY 2012-2013. A provider's appeal must be in writing and filed with the Department's Bureau of Hearings and Appeals, 2330 Vartan Way, 2nd Floor, Harrisburg, PA 17110-9721, within 33 days of the date of the Department's letter notifying the facility of its final rates. Facilities should refer to 67 Pa.C.S. Chapter 11 (relating to Medical Assistance hearings and appeals) and to the Department's regulations at 55 Pa. Code Chapter 41 (relating to Medical Assistance provider appeal procedures) for more detail regarding their appeal rights and the requirements related to written appeals.
Fiscal Impact
There is no fiscal impact for the change in final payment rates for FY 2012-2013 per diem rate payments to nonpublic and county nursing facilities compared to the facilities' final FY 2011-2012 per diem rates.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, P. O. Box 8025, Harrisburg, PA 17105-8025. 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).
BEVERLY D. MACKERETH,
SecretaryFiscal Note: 14-NOT-868. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 14-1212. Filed for public inspection June 6, 2014, 9:00 a.m.]
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