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PA Bulletin, Doc. No. 09-1035

NOTICES

Payment for Nursing Facility Services Provided by County Nursing Facilities; Change in Methods and Standards of Setting Payment Rates

[39 Pa.B. 2900]
[Saturday, June 6, 2009]

Purpose

   This announcement is to provide advance notice that the Department of Public Welfare (Department) intends to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services for qualified county nursing facilities for Fiscal Years (FY) 2009-2010, 2010-2011 and 2011-2012.

   For FY 2006-2007 through 2008-2009 the Department provided pay for performance incentive payments to qualified county nursing facilities. The qualifying criteria and formula used to determine those payments is set forth in the Commonwealth's approved State Plan.

   The Department intends to continue the pay for performance incentive payments to qualifying county nursing facilities for FYs 2009-2010, 2010-2011 and 2011-2012. To qualify for these payments a county nursing facility must be a county nursing facility at the time of payment and its MA case mix index (CMI) for the picture date within the pay for performance payment period must be higher than its facility MA CMI for the previous picture date. To determine the payments, the Department will ascertain the total quarterly funds available for the performance incentive payments and divide that amount by the total MA days for all county nursing facilities meeting the qualifying criteria. The MA days used for each county nursing facility will be the paid MA days identified on the most recent PROMISe data file used to determine eligibility for disproportionate share payments.

   To authorize the continuation of the payments for FYs 2009-2010, 2010-2011 and 2011-2012, the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS).

   Contingent upon the approval by CMS of the SPA, the Department will continue pay for performance incentive payments to qualified county nursing facilities for FYs 2009-2010, 2010-2011 and 2011-2012. The first payment for 2009-2010 will not be made prior to the second quarter of FY 2009-2010. The payments will be made quarterly to qualified county nursing facilities according to the criteria and formula set forth in the Commonwealth's approved State Plan.

Fiscal Impact

   The change in payment rates is estimated to cost the Department $6.500 million ($2.245 million in State funds) in FY 2009-2010, $6.500 million ($2.578 million in State funds) in FY 2010-2011.

Public Comment

   Interested persons are invited to submit written comments 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,   
Secretary

   Fiscal Note: 14-NOT-599. (1) General Fund; (2) Implementing Year 2009-10 is $2,245,000; (3) 1st Succeeding Year 2010-11 is $2,578,000; 2nd Succeeding Year 2011-12 is $2,578,000; 3rd Succeeding Year 2012-13 is NA; 4th Succeeding Year 2013-14 is NA; 5th Succeeding Year 2014-15 is NA; (4) 2007-08 Program--$692,585,000; 2006-07 Program--$695,279,000; 2005-06 Program--$817,890,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 09-1035. Filed for public inspection June 5, 2009, 9:00 a.m.]


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