NOTICES
Payments to Nursing Facilities; January 1, 2003 Final Rates
[33 Pa.B. 2021] The purpose of this notice is to announce final payment rates for nursing facilities based on case-mix index (CMI) adjustments only, for nursing facility services provided on or after January 1, 2003, in accordance with 42 U.S.C.A. § 1396a(a)(13), as amended by section 4711 of the Balanced Budget Act of 1997 (Pub. L. No. 105-33). A January 1, 2003, proposed rates notice was published at 33 Pa.B. 693 (February 1, 2003) and provided for a 30-day comment period. The Department of Public Welfare (Department) did not receive any comments on the proposed January 1, 2003, rate notice.
Rates
The final January 1, 2003, rates are available at the local county assistance offices throughout this Commonwealth, on the Office of Medical Assistance Programs' website at www.dpw.state.pa.us/omap or by contacting Tom Jayson, Policy Unit, Bureau of Long Term Care Programs, (717) 705-3705.
Methodology
The methodology that the Department used to set the final rates based on CMI adjustments is contained in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting) and the Commonwealth's approved Title XIX State Plan.
Justification
The justification for establishing the final rates is that they were set under the rate setting methodology required by the Commonwealth's regulations and approved State Plan.
Appeals
A Medical Assistance nursing facility provider that has not submitted a signed Certification and Settlement Agreement for Year 8 (July 1, 2002--June 30, 2003) may file an administrative appeal if it believes that the Department made any errors or the provider otherwise disagrees with its Year 8 rates. A provider's appeal must be in writing, sent to the Department's Bureau of Hearings and Appeals, P. O. Box 2675, Harrisburg, PA 17102, and received by the Bureau of Hearings and Appeals within 30 days of the date of the Department's letter notifying the provider of its final rates. The filing of an appeal constitutes the exclusive way by which a provider can present the Department with a demand that a final rate be modified, reversed, rescinded or otherwise altered or with a demand that the Department increase the amount of reimbursement paid to the provider under that rate. If a provider chooses to appeal, the provider will be afforded the opportunity for a de novo hearing before the Bureau of Hearings and Appeals. The provider's rates may be changed as a result of the final adjudication of the appeal. Providers should refer to 55 Pa. Code § 1187.141 (relating to nursing facility's right to appeal and to a hearing) for more detail regarding their appeal rights and the requirements related to their written appeals.
Fiscal Impact
The estimated increase in annual aggregate expenditures for Medical Assistance nursing facility services for FY 2002-2003 based on these final rates is $6.239 million ($2.827 million in State funds).
Interested persons are invited to submit written comments about the final rates to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin. Comments should be addressed to Department of Public Welfare, Office of Medical Assistance Programs, Attention: Suzanne Love, P. O. Box 2675, Harrisburg, PA 17105.
Persons with a disability may use the AT&T Relay Services by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-353. (1) General Fund; (2) Implementing Year 2002-03 is $2,827,000; (3) 1st Succeeding Year 2003-04 is $8,470,000; 2nd Succeeding Year 2004-05 is $8,470,000; 3rd Succeeding Year 2005-06 is $8,470,000; 4th Succeeding Year 2006-07 is $8,470,000; 5th Succeeding Year 2007-08 is $8,470,000; (4) 2001-02 Program--$761,877,000; 2000-01 Program--$722,565,000; 1999-00 Program--$693,625,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. Funding for these changes is included in the 2002-03 and 2003-04 budgets.
[Pa.B. Doc. No. 03-719. Filed for public inspection April 18, 2003, 9:00 a.m.]
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