NOTICES
Payments to Nonpublic Nursing Facilities; Final Rates for State Fiscal Year 2008-2009
[39 Pa.B. 1596]
[Saturday, March 28, 2009]The purpose of this notice is to announce the Department of Public Welfare's (Department) final annual case-mix per diem payment rates for State Fiscal Year (FY) 2008-2009 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 annually sets a new MA per diem rate for each nonpublic nursing facility. Each facility's annual per diem rate is comprised of four components: resident care; other resident related; administrative; and capital.
The act of July 4, 2008 (P. L. 31, No. 44) (Act 44), among other things, directed the Department for FY 2008-2009 to apply a budget adjustment factor (BAF) to nonpublic nursing facility payment rates and continue to include the costs incurred by county nursing facilities in the rate-setting database used for the purpose of calculating nonpublic nursing facility payment rates.
The Federal Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 08-007 on December 12, 2008. SPA 08-007 states that the BAF for rate setting year 2008-2009 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 so that the aggregate percentage rate of increase for the period that begins July 1, 2005, and ends on June 30, 2009, is limited to the amount permitted by the funds appropriated by the General Appropriations Act of 2008 (Act 38A). For the rate setting year beginning July 1, 2008, and ending June 30, 2009, the BAF for nonpublic nursing facilities is equal to .90891.
CMS approved SPA 08-015 on October 30, 2008. SPA 08-015 authorizes the Department to continue the inclusion of county nursing facility costs in the process of computing the peer group prices used to set per diem rates for nonpublic nursing facilities for FY 2008-2009.
The final FY 2008-2009 annual per diem rates are available on the web site for the Department of Public Welfare at www.dpw.state.pa.us/PartnersProviders/LongTermLiving/. As they become available, the adjusted quarterly rates for the October, January and April quarters of FY 2008-2009 will be accessible on the Department's web site, at local county assistance offices throughout this Commonwealth or by contacting Gail Weidman, Office of Long-Term Living at (717) 705-3705.
Public Process
The Department published a notice in the Pennsylvania Bulletin announcing its proposed case-mix per diem payment rates for FY 2008-2009 at 38 Pa.B. 6343 (November 15, 2008) and invited interested persons to submit comments. No comments were received by the Department in response to the proposed rate notice.
Appeals
Following publication of this notice, the Department will send rate letters to each MA nursing facility to notify the facilities of their final rates for FY 2008-2009. The rate letter will also advise each facility that it may file an administrative appeal if the facility believes that the Department made any errors or otherwise disagrees with its final rates for FY 2008-2009. A provider's appeal must be in writing and filed with the Department's Bureau of Hearings and Appeals, P. O. Box 2675, Harrisburg, PA 17105, within 33 days of the date of the Department's letter notifying the facility of its final rates. Facilities should refer to 67 Pa.C.S. Chapter 11 (relating to medical assistance hearings and appeals), and to the Department's regulations at 55 Pa. Code Chapter 41 (relating to medical assistance provider appeal procedures), for more detail regarding their appeal rights and the requirements related to their written appeals.
Fiscal Impact
The change in payment rates, effective July 1, 2008, will result in an estimated cost of $32.302 million ($14.726 million in State funds) for nonpublic nursing facilities in 2008-2009 compared to the final April 1, 2008 rates. Funding for these changes has been included in the MA Long-Term Care appropriation.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the 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 Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-590. (1) General Fund; (2) Implementing Year 2008-09 is $14.726 M; (3) 1st Succeeding Year 2009-10 is $16.065 M; 2nd Succeeding Year 2010-11 is $16.065 M; 3rd Succeeding Year 2011-12 is $16.065 M; 4th Succeeding Year 2012-13 is $16.065 M; 5th Succeeding Year 2013-14 is $16.065 M; (4) 2007-08 Program--$692.585 M; 2006-07 Program--$695.279 M; 2005-06 Program--$817.890; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 09-590. Filed for public inspection March 27, 2009, 9:00 a.m.]
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