NOTICES
Payments to Special Rehabilitation Nursing Facilities; Final Rates for November 1, 2011, through June 30, 2012
[44 Pa.B. 3393]
[Saturday, June 7, 2014]This notice announces the Department of Public Welfare's (Department) final case-mix per diem payment rates for the period November 1, 2011, through June 30, 2012, for the four nursing facilities classified as special rehabilitation nursing facilities (SRF) on or before July 1, 2000.
As required by the case-mix payment methodology regulations in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department annually sets an annual Medical Assistance (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.
The case-mix rates for SRFs are calculated using the same methodology as all other nonpublic nursing facilities except that, for the purposes of establishing peer group medians and prices, SRFs are classified in one Statewide peer group without regard to their size or geographic location. Retroactive to November 1, 2011, peer group medians and peer group prices were established for facilities classified as SRFs on or before July 1, 2000, separate from any other facilities meeting the definition of an SRF. Peer group medians and prices for facilities classified as SRFs after July 1, 2000, were established using data from all facilities meeting the definition of an SRF. See 44 Pa.B. 3322 (June 7, 2014); 55 Pa. Code § 1187.94(2)(i) and (ii) (relating to peer grouping for price setting).
Section 1187.96 of 55 Pa. Code (relating to price- and rate-setting computations) authorized a 3-year phase-in 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 Fiscal Year (FY) 2011-2012, the nursing facility's blended resident care rate will equal 50% 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 50% of the nursing facility's RUG v 5.12 resident care rate.
In addition, the act of June 30, 2011 (P. L. 89, No. 22) amended the Public Welfare Code (62 P. S. §§ 101—1503) to authorize the Department to continue to apply a budget adjustment factor (BAF) in calculating rates for MA nonpublic and county nursing facilities for each fiscal year between July 1, 2011, and June 30, 2013. The Federal Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 11-015 on November 21, 2011. SPA 11-015 states that the BAF shall limit payment rates for MA nursing facility services for county and nonpublic nursing facilities so that the Statewide day-weighted average payment rate for FY 2011-2012 is limited to the amount permitted by the funds appropriated by the General Appropriations Act of 2011. For FY 2011-2012, a BAF was calculated each quarter for nonpublic nursing facilities as stated in 42 Pa.B. 2111 (April 14, 2012). SPA 11-028, which specified that the change in rate methodology related to the SRFs not be a factor in the quarterly BAF calculations for the period November 1, 2011, through June 30, 2012, was submitted to CMS on December 28, 2011. CMS approved SPA 11-028 on March 13, 2012, with an effective date of November 1, 2011.
The final per diem rates for the period November 1, 2011, through June 30, 2012, for the four nursing facilities classified as SRFs on or before July 1, 2000, (Good Shepherd Home Raker Center, Inglis House, Margaret E. Moul Home and Good Shepherd Home-Bethlehem) 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 in the Pennsylvania Bulletin announcing its proposed case-mix per diem payment rates for the initial four SRFs that partici- pate in the MA Program for the period November 1, 2011, through June 30, 2012, at 42 Pa.B. 2111 and invited interested persons to submit comments. No comments were received by the Department in response to the notice. In addition, the Department received one public comment within the 30-day public comment period in response to the notice published at 41 Pa.B. 5826 (October 29, 2011) regarding redistribution of dollars away from the other nonpublic nursing facilities as a result of the change in rate methodology for special rehabilitation nursing facilities. As provided in response to question #14 of the Regulatory Analysis Form related to the proposed rulemaking Payment for Nursing Facility Services Provided by Special Rehabilitation Nursing Facilities published at 43 Pa.B. 4599 (August 10, 2013), other nonpublic nursing facilities may see a minimal positive impact. No comments were received by the Department in response to the proposed rulemaking.
Appeals
Following publication of this notice, the Department will send rate letters to notify the four SRFs of their final rates for the period November 1, 2011, through June 30, 2012. The rate letter will also advise the 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 the period November 1, 2011, through June 30, 2012. 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 in 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
The estimated fiscal impact for the change in payment rates for the four SRFs for the period November 1, 2011, through June 30, 2012, is $0.331 million in State funds. For FY 2012-2013 and beyond, the fiscal impact will remain budget neutral as long as the BAF continues to be reauthorized; the act of July 9, 2013 (P. L. 369, No. 55) extends use of a BAF through June 30, 2016.
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-870. (1) General Fund; (2) Implementing Year 2011-12 is $331,000; (3) 1st Succeeding Year 2012-13 is $0; 2nd Succeeding Year 2013-14 is $0; 3rd Succeeding Year 2014-15 is $0; 4th Succeeding Year 2015-16 is $0; 5th Succeeding Year 2016-17 is $0; (4) 2010-11 Program—$728,907,000; 2009-10 Program—$540,266,000; 2008-09 Program—$672,597,000; (7) MA—Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 14-1214. Filed for public inspection June 6, 2014, 9:00 a.m.]
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