NOTICES
Payments to Nonpublic Nursing Facilities; Proposed Rates for State Fiscal Year 2007-2008
[37 Pa.B. 5573]
[Saturday, October 13, 2007]Purpose of Notice
This notice announces the Department of Public Welfare's (Department) proposed annual case-mix per diem payment rates for State Fiscal Year (FY) 2007-2008 for nonpublic nursing facilities that participate in the Medical Assistance (MA) Program.
As required by the case-mix payment methodology set forth in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department intends to set a new annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate will have four components: resident care; other resident related; administrative and capital. For each quarter of FY 2007-2008, the Department will adjust the resident care component of each facility's rate by multiplying the resident care cost component by the facility's MA case-mix index (CMI) for the appropriate picture date. In addition, the Department will adjust each facility's CMI-adjusted quarterly rate by multiplying the rate by a ''budget adjustment factor'' (BAF).
As required by 55 Pa. Code § 1187.96(e)(2)(iv) (relating to price- and rate-setting computations), the Department intends to follow the formula set forth in the Commonwealth's approved State Plan to determine the BAF for FY 2007-2008. On June 29, 2007, the Department submitted State Plan Amendment (SPA) 07-007 to the Federal Centers for Medicare and Medicaid Services (CMS) to include the BAF formula which the Department will use in FY 2007-2008.
The Department published a public notice at 37 Pa.B. 3036 (June 30, 2007), which announced the BAF for county and nonpublic nursing facilities for FY 2007-2008 based on the funding provided in the Governor's executive budget. Subsequent to publication of the notice, the General Assembly approved the final budget bill. The Department has determined, based on the appropriation in the final budget, that the percentage rate of increase appropriated for nursing facility services for FY 2007-2008 is 3%.
The BAF for rate setting year 2007-2008 shall limit the estimated aggregate increase in the Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities over the 3 year period commencing July 1, 2005, and ending June 30, 2008, from the Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities in rate year 2004-2005 to 10.12%. The formula for this BAF as it applies to nonpublic nursing facilities is as follows: (the nonpublic nursing facilities' share of total appropriated funds plus the estimated annual patient pay amount) divided by the estimated acuity-adjusted annual payments of $3,147,260,444 which equals .93194.
Due to the change in the amount appropriated for nursing facilities, on July 26, 2007, the Department submitted revised State Plan pages for SPA 07-007 to CMS. Implementation of the BAF formula is contingent upon CMS' approval of SPA 07-007.
The proposed annual per diem rates for FY 2007-2008 are available on the website for the Office of Medical Assistance Programs (OMAP) at www.dpw.state.pa.us/omap and at local county assistance offices throughout the Commonwealth or by contacting Tom Jayson, Policy Unit, Office of Long-Term Living, at (717) 705-3705. In addition, the Department will calculate adjusted quarterly rates for the October, January and April quarters of FY 2007-2008 for each nonpublic MA nursing facility provider. These adjusted quarterly rates will be posted on the OMAP website, at local county assistance offices and from Tom Jayson, as they become available.
Fiscal Impact
The change in payment rates effective July 1, 2007, and the quarterly case-mix adjustments, are estimated to cost the Department $75.794 million ($34.746 million in State funds) in FY 2007-2008.
Public Comment
Interested persons are invited to submit written comments regarding the proposed annual rates for FY 2007-2008 or the BAF formula to the Department at the following address: Department of Public Welfare, Office of Long-Term Living, 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,
SecretaryFiscal Note: 14-NOT-528. (1) General Fund; (2) Implementing Year 2007-08 is $34,746,000; (3) 1st Succeeding Year 2008-09 is $37,905,000; 2nd Succeeding Year 2009-10 is $37,905,000; 3rd Succeeding Year 2010-11 is $37,905,000; 4th Succeeding Year 2011-12 is $37,905,000; 5th Succeeding Year 2012-13 is $37,905,000; (4) 2006-07 Program--$695,279,000; 2005-06 Program--$817,890,000; 2004-05 Program--$476,116,000; (7) Medical Assistance--Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover these increases.
[Pa.B. Doc. No. 07-1876. Filed for public inspection October 12, 2007, 9:00 a.m.]
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