NOTICES
Payment for Nursing Facility Services Provided by Nonpublic and County Nursing Facilities; Supplemental Ventilator Care Payment
[42 Pa.B. 3824]
[Saturday, June 30, 2012]The Department of Public Welfare (Department) is proposing to change its methods and standards for payment of Medical Assistance (MA) nursing facility services to offer a new category of supplemental payment to qualified MA nursing facilities beginning July 1, 2012.
Background
Currently, the Department pays for nursing facility services provided to MA eligible recipients in nonpublic nursing facilities at per diem rates that are computed using the case-mix payment system in the Department's regulations in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting). Beginning July 1, 2010, the payment methodology was changed to phase-in, over a 3-year period, use of the Resource Utilization Group III version 5.12 (RUG v. 5.12) classification system.
Now that the Department has implemented RUG v. 5.12 and the phase out of the older RUG v. 5.01 is nearing completion, consideration is being given to the financial impact on nursing facilities that care for a significant number of MA ventilator-dependent residents.
Proposed Changes
The Department is considering providing a supplemental ventilator care payment to both nonpublic and county nursing facilities that provide ventilator care for a significant portion of their MA resident population. This payment would be calculated on a quarterly basis and paid to nursing facilities caring for a minimum of ten MA ventilator care residents with at least 10% of the facility's MA resident population requiring ventilator care. For those nursing facilities meeting these qualifications, the total supplemental ventilator care payment would then be the nursing facility's supplemental ventilator care per diem times the number of paid MA facility days and therapeutic leave days. Since this payment is a supplemental payment and not part of the case-mix per diem rates, it will not be subject to the budget adjustment factor under 55 Pa. Code § 1187.96 (relating to price- and rate-setting computations).
A nursing facility's supplemental ventilator care per diem would be calculated as follows: ((number of MA ventilator care residents ÷ total MA residents) × $69) × (number of MA ventilator care residents ÷ total MA residents).
The maximum supplemental ventilator care per diem would be $69 for nursing facilities whose percent of MA ventilator care residents to total MA residents equals 100%. This formula results in the provision of higher supplemental ventilator care payments to facilities with the highest percent of MA ventilator care residents by providing payment based on the proportion of MA ventilator care residents to total MA residents. Finally, this supplemental payment is part of the Department's ongoing efforts to ensure that MA recipients continue to receive access to medically necessary nursing facility services and that those services result in quality care that improves the lives of those who receive them.
Fiscal Impact
This change will result in an estimated annual payment of $2.1 million in total funds ($0.956 million in State funds) in Fiscal Year 2012-2013.
Public Comment
Interested persons are invited to submit written comments regarding these proposed changes to the Department of Public Welfare, Office of Long-Term Living, Attention: Marilyn Yocum, Department of Public Welfare/Department of Aging, Office of Long-Term Living, Policy and Strategic Planning, 555 Walnut Street, Forum Place, 5th Floor, Harrisburg, PA 17101-1919. 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).
GARY D. ALEXANDER,
SecretaryFiscal Note: 14-NOT-776. (1) General Fund; (2) Implementing Year 2012-13 is $956,000; (3) 1st Succeeding Year 2013-14 is $0; 2nd Succeeding Year 2014-15 is $0; 3rd Succeeding Year 2015-16 is $0; 4th Succeeding Year 2016-17 is $0; 5th Succeeding Year 2017-18 is $0; (4) 2011-12 Program—$737,356,000; 2010-11 Program—$728,907,000; 2009-10 Program—$540,266,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 12-1225. Filed for public inspection June 29, 2012, 9:00 a.m.]
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