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PA Bulletin, Doc. No. 05-2282

NOTICES

Payments to Nursing Facilities; Proposed Rates for State Fiscal Year 2005-2006

[35 Pa.B. 6712]

   The Department of Public Welfare (Department) intends to make changes in the payment rates for Medical Assistance (MA) nursing facility providers for State Fiscal Year 2005-2006 (FY 05-06).

   Under the Department's case-mix payment methodology, the Department establishes a new case-mix per diem payment rate for each MA nursing facility provider once for each fiscal year. Each provider's annual case-mix per diem rate is comprised of four cost components: resident care; other resident related; administrative; and capital. For each quarter of the fiscal year, the Department adjusts the resident care cost component of each provider's rate by multiplying the resident care cost component by the provider's MA Case Mix Index for the appropriate picture date as follows: July 1 rate--February 1 picture date; October 1 rate--May 1 picture date; January 1 rate--August 1 picture date; and April 1 rate--November 1 picture date. See 55 Pa. Code § 1187.96 (relating to price and rate setting computations). The Department pays the provider for nursing facility services provided to MA recipients during that quarter using the provider's adjusted quarterly per diem rate.

   The Department has calculated new annual case-mix per diem payment rates for FY 05-06 for MA nursing facility providers. The methodology that the Department used to set the proposed rates is contained in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), as amended at 35 Pa.B. 6232 (November 12, 2005).

   The proposed FY 05-06 annual per diem rates are available on the Office of Medical Assistance Programs' (OMAP) website at www.dpw.state.pa.us/omap. The proposed FY 05-06 annual per diem rates are also available at local county assistance offices throughout this Commonwealth or by contacting Tom Jayson, Policy Unit, Bureau of Long Term Care Programs, (717) 705-3705.

   The Department has also calculated the adjusted quarterly rate for the October 2005 quarter for each MA nursing facility provider. The adjusted quarterly rates are also available on OMAP's website, at local county assistance offices and from Tom Jayson.

   The database that the Department used to calculate the rates is available on the OMAP's website. Since some of the audited cost reports in the database relate to fiscal periods beginning prior to January 1, 2001, the Department revised the audited costs in the database as specified in 55 Pa. Code § 1187.91(1)(iv)(D) (relating to database) to disregard certain audit adjustments disallowing minor movable property or linen costs. The criteria that the Department used to make these revisions are available on the OMAP's website or by contacting Tom Jayson.

Fiscal Impact

   The change in payment rates, effective July 1, 2005, and the quarterly case-mix adjustments are estimated to cost the Department $34.061 million ($15.413 million in State funds) in FY 05-06.

Public Comment

   Interested persons are invited to submit written comments regarding the proposed FY 05-06 rates to the Department of Public Welfare, Bureau of Long Term Care Programs, Attention: Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. 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 AT&T Relay Services at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note:  14-NOT-451. (1) General Fund; (2) Implementing Year 2005-06 is $15.413 million; (3) 1st Succeeding Year 2006-07 is $16.815 million; 2nd Succeeding Year 2007-08 is $16.815 million; 3rd Succeeding Year 2008-09 is $16.815 million; 4th Succeeding Year 2009-10 is $16.815 million; 5th Succeeding Year 2010-11 is $16.815 million; (4) 2004-05 Program--$983.936 million; 2003-04 Program--$836.317 million; 2002-03 Program--$777.084 million; (7) Medical Assistance, Long-Term Care; (8) recommends adoption. Funds have been included in the Department's budget to cover this increase.

[Pa.B. Doc. No. 05-2282. Filed for public inspection December 9, 2005, 9:00 a.m.]

   


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