NOTICES
DEPARTMENT OF
HUMAN SERVICES
Payment for Nursing Facility Services Provided by Nonpublic and County Nursing Facilities; Notice of Change for Supplemental Payments
[47 Pa.B. 6140]
[Saturday, September 30, 2017]This announcement is to provide notice that the Department of Human Services (Department) is proposing to adopt regulations and amend the Commonwealth's Title XIX State Plan to change its methods and standards for payment of Medical Assistance (MA) nursing facility services provided by nonpublic and county nursing facilities beginning January 1, 2018.
Background
On February 27, 2015, Governor Tom Wolf unveiled a package of legislative and budgetary actions which resulted in the Department working in partnership with the Department of Aging to pursue the implementation of the Commonwealth's new managed care program Community HealthChoices (CHC). CHC will begin in the Southwest zone on January 1, 2018, the Southeast zone on July 1, 2018, and the Lehigh Capital, Northwest and Northeast zones on January 1, 2019. A list of the counties in each zone is available at http://www.healthchoices.pa.gov/cs/groups/webcontent/documents/document/c_227013.pdf.
To prepare for the implementation of CHC, the Department is proposing to amend 55 Pa. Code §§ 1187.111(a), 1187.117(b) and 1189.105(a) and (c)(2) (relating to disproportionate share incentive payments; supplemental ventilator care and tracheostomy care payments; and incentive payments) to limit disproportionate share incentive payments and supplemental ventilator care and tracheostomy care payments to nursing facilities that are not located in a geographic zone where CHC operates. These supplemental payments will be phased out of the Fee-for-Service (FFS) delivery system in conjunction with the phase in of CHC, with payments continuing to be a part of FFS in non-CHC zones.
As CHC is implemented, nursing facility services provided under the FFS delivery system will be minimal. Therefore, payment history related to these payments was used in the development of CHC capitated rates. The capitated rates are certified as actuarially sound by an actuary and submitted to the Centers for Medicare & Medicaid Services for review and approval. CHC managed care organizations will then use the revenue they receive from the Department to pay their network providers, including nursing facilities, for the services they provide.
Fiscal Impact
No fiscal impact is anticipated as a result of these changes.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, 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).
TERESA D. MILLER,
Acting SecretaryFiscal Note: 14-NOT-1184. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 17-1634. Filed for public inspection September 29, 2017, 9:00 a.m.]
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