NOTICES
Nursing Facility Assessment Program
[35 Pa.B. 808] The General Assembly amended the Public Welfare Code by enacting the act of September 30, 2003 (P. L. 169, No. 25) (Act 25) authorizing the Department of Public Welfare (Department) to implement assessments on non-Federal, nonpublic licensed nursing facilities beginning Fiscal Year (FY) 2003-2004 and ending no later than FY 2006-2007. See sections 801-A--815-A of Act 25 (62 P. S. §§ 801-A--815-A).
The purpose of the assessments is ''to generate additional revenues for medical assistance recipients to have access to medically necessary nursing facility services.'' See section 802-A of Act 25. To assure that the assessments achieve their intended purpose, the assessments ''may be imposed only to the extent that the revenues generated therefrom will qualify as the State share of [medical assistance] program expenditures eligible for Federal financial participation.'' See section 803-A of Act 25. The Department must seek a waiver, if necessary, from the Federal Centers for Medicare and Medicaid Services (CMS) to make sure that the assessment revenues qualify for Federal matching funds. See section 812-A of Act 25.
The Secretary of the Department (Secretary), in consultation with the Secretary of the Budget, must determine the aggregate amount of the assessment and the annual assessment rate for each FY that the assessments are implemented. See section 804-A of Act 25. The aggregate amount and rate of assessment must be approved by the Governor. The annual assessment rates must be sufficient to generate at least $50 million in additional revenue, subject to the maximum aggregate assessment amount that qualifies for Federal matching funds.
Before implementing an assessment in a fiscal year, the Secretary must publish a notice in the Pennsylvania Bulletin that specifies the amount of the assessment being proposed, provides an explanation of the assessment methodology and assessment amount and identifies the aggregate impact on nursing facilities subject to the assessment. See section 805-A of Act 25.
This notice announces the amount of the assessments and the rates of assessment that the Department is proposing to implement for FY 2003-2004 and FY 2004-2005.
Assessment Methodology, Rates and Amounts
Since the enactment of Act 25 authorizing the assessment program, the Department has sought to design an assessment program that meets applicable Federal requirements. The CMS, after rejecting several initial proposals submitted by the Department, has approved the following assessment program which will generate revenues that qualify for Federal matching funds:
The assessment program will employ different levels of assessments and will limit the assessments to nonexempt nursing facilities. The following nursing facilities will be exempt from the assessment program:
(1) Government owned and operated nursing facilities.
(2) Veteran's Administration nursing facilities.
(3) Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter in which an assessment is collected.
Nonexempt nursing facilities will be assessed on a quarterly basis based on the number of licensed beds in the facility and the number of non-Medicare resident days during each calendar quarter in which an assessment is implemented.
In the development of the assessment rates, the Department recognized that some nursing facilities, due totheir bed size or their contractual obligations with their residents, might not have the capacity to assume the burden of the assessment and still remain in business. To address this issue, the Department developed two assessment rates, a rate for smaller nursing facilities and Continuing Care Retirement Communities (CCRC) and a rate for all other nonexempt nursing facilities.
The assessment amount and rate for each nonexempt nursing facility will be as follows:
(1) Nonexempt nursing facilities participating within licensed CCRCs and nonexempt nursing facilities with 50 licensed beds or less will be assessed at $1.50 per non-Medicare resident day.
(2) All other nonexempt nursing facilities will be assessed at $15.91 per non-Medicare resident day.
The revenue generated by the assessment program, when combined with Federal matching funds, will enable the Department to maintain rates under the existing case-mix payment methodology (55 Pa. Code Chapter 1187 (relating to nursing facility services)) in FY 2003-2004 and FY 2004-2005 and provide additional supplemental payments to qualified Medical Assistance nursing facility providers.
Aggregate Assessment Amounts and Fiscal Impact
Due to delays in obtaining Federal approval, the assessment program is being implemented retroactively to FY 2003-2004. Therefore, both the FY 2003-2004 and FY 2004-2005 assessments will occur in FY 2004-2005. The following amount listed for FY 2004-2005 represents the combined total of the FY 2003-2004 estimated assessment revenue of $280.065 million and the FY 2004-2005 estimated revenue of $277.755 million.
Public Comment
Interested persons are invited to submit written comments regarding the contents of this notice to Gail Weidman, Chief, Program Analysis and Review Section, Department of Public Welfare, Division of Long Term Care Client Services, P. O. Box 2675, Harrisburg, PA 17105. Comments must be submitted within 30 days of publication of the notice. See section 805-A of the Act 25. After considering the comments, the Secretary will publish a second notice announcing the final assessment rate for FY 2003-2004 and FY 2004-2005. 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 AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-408. No fiscal impact; (8) recommends adoption. This public notice provides advance notice of the amount and rate of assessment for FY 2003-04 and FY 2004-05. Both assessments will occur during FY 2004-05 and are estimated to provide $557,820,000 in total additional revenue to supplement the Medical Assistance--Long Term Care Appropriation.
[Pa.B. Doc. No. 05-252. Filed for public inspection February 4, 2005, 9:00 a.m.]
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