NOTICES
Payments to Nonpublic and County Nursing Facilities; Proposed Rates for State Fiscal Year 2014-2015
[44 Pa.B. 3821]
[Saturday, June 21, 2014]This notice announces the Department of Public Welfare's (Department) proposed annual case-mix per diem payment rates for State Fiscal Year (FY) 2014-2015 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 intends to set an annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate will have four components: resident care; other resident related; administrative; and capital. For each quarter of FY 2014-2015, the Department will adjust the resident care component of each facility's rate by multiplying the resident care component by the facility's MA case-mix index (CMI) for the appropriate picture date.
In calculating the proposed rates, the Department assumed that peer group prices for FY 2014-2015 will be set as specified in 55 Pa. Code § 1187.94 (relating to peer grouping for price setting) except that for facilities classified as special rehabilitation facilities on or before July 1, 2000, peer group medians and prices will be 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).
In addition, as required by section 443.1(7)(iv) of the Public Welfare Code (62 P. S. § 443.1(7)(iv)), regarding MA payments for institutional care, the Department intends to adjust each facility's CMI-adjusted quarterly rate by multiplying the rate by a budget adjustment factor (BAF). The Federal Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 13-022 on November 7, 2013, which includes the BAF formula the Department will use for nonpublic nursing facilities in FY 2014-2015. A detailed description of this formula is as follows:
Nonpublic Nursing Facilities' BAF Determination
Base BAF Formula—Prior to establishing the July rate for the 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.
If the base BAF as calculated is greater than 1.0, the base BAF will equal 1.0.
April BAF Formula—Prior to establishing the April rate for the 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 difference between the weighted average April rate and the April target rate is $0.25 or more, the formula for the April BAF will be the April target rate divided by the weighted average April rate at 100% equals the April BAF. Otherwise, the April BAF is equal to the base BAF.
Terms Related to the BAF Determination
The following words and terms, when used in the BAF determination, 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%. For FY 2014-2015, the base days are the sum of each nonpublic nursing facility's paid facility days, therapeutic leave days and 1/3 of the paid hospital bed reserve days from the PROMISe data file used to determine the June 30, 2013, disproportionate share payments.
Base rate—The base rate is the prior year's annual 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 calculated using base days prior to application of the base BAF.
The 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.1
Finally, in calculating the proposed rates, the Department assumed that the General Appropriations Act of 2014 will include the level of funding in the Governor's Executive Budget.
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 intends to set an annual MA per diem rate for each county nursing facility provider. As specified 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 multiplied by a BAF determined in accordance with the formula in the Commonwealth's approved State Plan. CMS approved SPA 13-021 on November 7, 2013 which includes the BAF formula the Department will use for county nursing facilities in FY 2014-2015. The formula is as follows: BAF = 1.00 + the percentage rate of change permitted by the funds appropriated by the General Appropriations Act for the applicable rate year. In calculating the proposed rates, the Department assumed that the General Appropriation Act of 2014 will include the level of funding in the Governor's Executive Budget.2
The proposed annual per diem rates for FY 2014-2015, the base BAF that will be applied to nonpublic nursing facility rates and the annual BAF that will be applied to county nursing facilities 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.
Fiscal Impact
If the proposed payment rates are adopted as final, the rates will result in an estimated cost of $43.772 million ($20.903 million in State funds) for per diem rate payments to nonpublic nursing facilities and an estimated cost of $8.579 million ($4.097 million in State funds) for per diem rate payments for county nursing facilities' FY 2014-2015 rates compared to the facilities' FY 2013-2014 per diem rates. The amount of funding available for this program is dependent upon the funds appropriated by the General Assembly in the forthcoming fiscal year. The Department assumed that funding for these changes will be included in the MA Long-Term Care appropriation.
Public Comment
Interested persons are invited to submit written comments regarding the proposed annual rates for FY 2014-2015 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-883. (1) General Fund; (2) Implementing Year 2014-15 is $25,000,000; (3) 1st Succeeding Year 2015-16 is $27,273,000; 2nd Succeeding Year 2016-17 is $27,273,000; 3rd Succeeding Year 2017-18 is $27,273,000; 4th Succeeding Year 2018-19 is $27,273,000; 5th Succeeding Year 2019-20 is $27,273,000; (4) 2013-14 Program—$838,528,000; 2012-13 Program—$770,903,000; 2011-12 Program—$737,356,000; (7) MA—Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 14-1318. Filed for public inspection June 20, 2014, 9:00 a.m.] _______
1 The Department will finalize the BAF once the General Assembly has enacted a General Appropriations Act for FY 2014-2015 and will include the BAF in its notice announcing final MA nursing facility payment rates for the rate-setting year.
2 The Department will finalize the BAF once the General Assembly has enacted a General Appropriations Act for FY 2014-2015 and will include the BAF in its notice announcing final MA nursing facility payment rates for the rate-setting year.
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