NOTICES
DEPARTMENT OF
HUMAN SERVICES
Nursing Facility Assessment Program for Fiscal Year 2022-2023
[52 Pa.B. 6120]
[Saturday, September 24, 2022]This notice announces the proposed assessment amount, the proposed assessment methodology and the estimated aggregate impact on nursing facilities that will be subject to the assessment under the Nursing Facility Assessment Program (Assessment Program) beginning in Fiscal Year (FY) 2022-2023.
Background
Article VIII-A of the Human Services Code (code) (62 P.S. §§ 801-A—815-A) authorizes the Department of Human Services (Department) to impose an annual monetary assessment on nonpublic and county nursing facilities in this Commonwealth. See 62 P.S. §§ 803-A and 815-A.1
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 Medical Assistance (MA) Program expenditures eligible for Federal financial participation (FFP). 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 2022-2023. The Department will submit a waiver request to CMS to implement changes to the Assessment Program as described in this notice. The implementation of these changes is contingent on CMS's approval of the waiver request.
For each fiscal year that the Assessment Program is implemented, the Secretary of the Department (Secretary) determines the aggregate amount of the assessment and the annual assessment rates in consultation with the Secretary of the Budget. See 62 P.S. § 804-A. The annual assessment rates must be sufficient to generate at least $50 million in additional revenue, but not more than the maximum aggregate assessment amount that qualifies for FFP. See 62 P.S. § 804-A.
Before imposing an annual assessment for a fiscal year, the Secretary must publish a notice in the Pennsylvania Bulletin. The notice must specify the amount of the assessment being proposed, explain the proposed assessment methodology, identify the estimated assessment amount and aggregate impact on nursing facilities subject to the assessment and provide interested persons a 30-day period to comment. See 62 P.S. § 805-A.
This notice announces the assessment amounts, rates and methodology that the Department is proposing to implement in FY 2022-2023 and the estimated aggregate impact on nursing facilities that will be subject to the assessment in FY 2022-2023.
Proposed Assessment Methodology and Rates
During FY 2022-2023, the Department is proposing to modify the assessment methodology by now including in the lower rate tier nursing facilities with at least 90,000 MA days and with an overall occupancy rate of 77% or higher based on Calendar Year (CY) 2021 resident days data. No other changes to the current assessment methodology have been made. For FY 2022-2023 the Department is also proposing a uniform $3.76 increase to the FY 2021-2022 assessment rates for both tiers. For the period July 1, 2022, to December 31, 2022, the Department is proposing to calculate the quarterly assessment amount for each nonexempt nursing facility by multiplying its assessment rate by the facility's historical non-Medicare resident days for the period January 1, 2021, to June 30, 2021, and dividing that amount by two. For the period January 1, 2023, to June 30, 2023, the Department intends to calculate each nonexempt facility's quarterly assessment amount by multiplying its assessment rate by the facility's non-Medicare resident days during the calendar quarter that immediately preceded the assessment quarter.
With these modifications, the Assessment Program will be implemented as follows:
For FY 2022-2023, the assessment will be imposed on all licensed nursing facilities in this Commonwealth except the following nursing facilities, which will be exempt from the Assessment Program:
(1) State-owned and operated nursing facilities;
(2) Veteran's Administration nursing facilities;
(3) Nursing facilities that provide nursing facility services free of charge to all residents; and
(4) Nursing facilities that have not been licensed and operated by either the current or a previous owner for the full calendar quarter prior to the calendar quarter for which an assessment is collected. A nursing facility that changes ownership is not considered a newly licensed nursing facility for assessment purposes.
For FY 2022-2023, the Department is proposing to continue to assess nonexempt nursing facilities at two rates. The Department is proposing to assess a rate of $9.32 to the following five categories of nursing facilities:
• County nursing facilities.
• Nursing facilities that have 44 or fewer licensed beds.
• Certain continuing care retirement community (CCRC) nursing facilities (see 40 Pa.B. 7297 (December 18, 2010)).
• Nursing facilities with an MA occupancy rate of at least 94% based on CY 2021 resident days as of July 19, 2022. For the purpose of qualifying for the lower assessment rate, a nursing facility's MA occupancy rate will be calculated as follows: MA Occupancy Rate = Sum of Total PA MA Days from the CY 2021 resident days data ÷ Sum of Total Resident Days from the CY 2021 resident days data, rounded to two decimals (nearest whole percent).
• Nursing facilities with at least 90,000 MA days and with an overall occupancy rate of 77% or higher based on the CY 2021 resident days as of July 19, 2022. For the purpose of qualifying for the lower assessment rate, a nursing facility's overall occupancy rate will be calculated as follows: Overall Occupancy Rate = Sum of Total Resident Days from CY 2021 resident days as of July 19, 2022 ÷ (number of licensed beds as of February 10, 2022 × 365), rounded to two decimals (nearest whole percent). The denominator uses 365 days unless the State fiscal year includes an additional day due to leap year in which case 366 days will be used.
For all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010, the Department is proposing to assess these facilities at a rate of $33.41.
Aggregate Assessment Amounts and Fiscal Impact
The Department estimates that if the proposed assessment rates are implemented the annual aggregate assessment fees for nonexempt nursing facilities will total $447.337 million. The Department will use the State revenue derived from the assessment fees and any associated FFP to support payments to qualified MA nursing facility providers in accordance with applicable laws and regulations.
Public Comment
Interested persons are invited to submit written comments regarding this proposed assessment to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Robyn Kokus, P.O. Box 8025, Harrisburg, PA 17105-8025 or at RA-PWOLTLNFPUBLICCOM@pa.gov. Comments must be submitted within 30 days of publication of this notice. See 62 P.S. § 805-A. After considering the comments, the Secretary will publish a second notice announcing the final assessment rates for FY 2022-2023. The Department will not begin collecting assessment fees until after the publication of the final assessment rate notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1533. (1) General Fund; (2) Implementing Year 2022-23 is -$447,337,000; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $0; (4) 2021-22 Program—$4,252,000,000; 2020-21 Program—$3,166,000,000; 2019-20 Program—$2,329,000,000; (7) Community HealthChoices; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 22-1486. Filed for public inspection September 23, 2022, 9:00 a.m.] _______
1 Act 54 of 2022, § 16 amended the Commonwealth's Fiscal Code to reauthorize the assessment under Article VIII-A through June 30, 2026. See 72 P.S. § 1606-T.
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