NOTICES
DEPARTMENT OF
HUMAN SERVICES
Payment for Nursing Facility Services; Nonpublic Nursing Facility Supplemental Payment and County Nursing Facility Medical Assistance Day One Incentive Payment for Fiscal Year 2019-2020
[49 Pa.B. 3413]
[Saturday, June 29, 2019]The Department of Human Services (Department) provides advance notice that the Department intends to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services beginning in Fiscal Year (FY) 2019-2020.
Background
Until June 30, 2019, Article VIII-A of the Human Services Code (code) authorizes the Department to impose an annual monetary assessment on nonpublic and county nursing facilities in this Commonwealth each fiscal year. See 62 P.S. §§ 801-A—815-A. The Department uses the revenue from the assessment to fund certain MA payments. The Department anticipates that the General Assembly will enact legislation to reauthorize the assessment. Therefore, the Department issues this notice in preparation of reauthorization of the assessment.
Under Article VIII-A of the code, the Department may impose the assessment only to the extent that the assessment revenues qualify as the State share of MA Program expenditures eligible for Federal financial participation (FFP). See 62 P.S. § 803-A. To ensure receipt of FFP, Article VIII-A of the code requires the Department to seek a waiver from the Centers for Medicare & Medicaid Services (CMS) if necessary to implement the Assessment Program. See 62 P.S. § 812-A. For FY 2019-2020, the Department will submit a request to CMS for the continuation and an amendment to the Assessment Program.
A portion of the revenue generated from the assessment will enable the Department to continue to set payment rates for MA nursing facility services under the existing fee-for-service payment system.
In addition, for nonpublic nursing facilities, funds from the assessment will be used to reimburse the MA allowable assessment costs and to continue the supplemental payments as described in the Department's currently approved State Plan. To receive the allowable assessment cost add-on and the supplemental payments, qualified nursing facilities must be located in a geographic zone where Community HealthChoices (CHC) does not operate during the entire corresponding assessment quarter. To authorize the continuation of these supplemental payments beginning July 1, 2019, the Department will submit a State Plan Amendment (SPA) to CMS.
For county nursing facilities, a portion of the revenue generated by the assessment will be used to fund the county nursing facility MA Day One Incentive (MDOI) Payments provided for in the Department's currently approved State Plan. MDOI Payments will be determined quarterly in FY 2019-2020. In addition, a county nursing facility will not qualify for a quarterly MDOI Payment if they are located in a geographic zone where CHC operates during the entire quarter for which the payment is being made. To authorize the continuation of these MDOI Payments beginning July 1, 2019, the Department will submit a SPA to CMS.
If CMS approves the SPA, the Department will have the authority to make the supplemental payments, including the allowable assessment cost add-on, to nonpublic nursing facilities and the MDOI Payments to county nursing facilities.
Fiscal Impact
The FY 2019-2020 fiscal impact for these supplemental payments is estimated at $155.932 million ($74.458 million in State funds).
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,
SecretaryFiscal Note: 14-NOT-1344. (1) General Fund; (2) Implementing Year 2018-19 is $0; (3) 1st Succeeding Year 2019-20 is $74,458,000; 2nd Succeeding Year 2020-21 through 5th Succeeding Year 2023-24 are $0; (4) 2017-18 Program—$1,099,000,000; 2016-17 Program—$1,082,000,000; 2015-16 Program—$968,083,000; (7) Long-Term Care; (8) recommends adoption. A portion of the revenue generated from nonpublic/county nursing facility assessment will be used to cover the increase. Reauthorization of the assessment is pending final enactment by the General Assembly.
[Pa.B. Doc. No. 19-979. Filed for public inspection June 28, 2019, 9:00 a.m.]
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