NOTICES
DEPARTMENT OF
HUMAN SERVICES
Payment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Medical Assistance Day One Incentive Payments to Nonpublic Nursing Facilities for Fiscal Year 2019-2020
[49 Pa.B. 5766]
[Saturday, October 5, 2019]This announcement provides advance notice that the Department of Human Services (Department) intends to continue to make Medical Assistance Day One Incentive (MDOI) payments to qualified nonpublic nursing facilities for Fiscal Year (FY) 2019-2020. The MDOI payments to nonpublic nursing facilities will provide incentives to nonpublic nursing facilities to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission. The MDOI payments are intended to encourage nonpublic nursing facilities to increase access to care for the poor and indigent citizens of this Commonwealth.
Nonpublic Medical Assistance Day One Incentive Payments
The Department will use the Total Pennsylvania Medical Assistance (PA MA) days and Total Resident Days as reported by nonpublic nursing facilities under Article VIII-A of the Human Services Code (62 P.S. §§ 801-A—815-A), regarding nursing facility assessments, to determine eligibility and calculate payments.
To qualify for MDOI payments, the nursing facility must be a nonpublic nursing facility for the full Resident Day quarter prior to the applicable quarterly reporting due dates of October 31, 2019, and January 31, 2020, and have submitted the required resident day reports for those due dates. In addition, the nonpublic nursing facility shall have an overall occupancy rate of at least 85% and an MA occupancy rate of at least 65% during the applicable Resident Day quarter. A nursing facility's overall occupancy rate for these payments will be determined as follows: Overall occupancy rate = (Total Resi-dent Days ÷ (licensed bed capacity at the end of the quarter × the number of calendar days in the quarter)). A nursing facility's MA occupancy rate for these payments will be determined as follows: MA occupancy rate = Total PA MA days ÷ Total Resident Days.
Each nursing facility may qualify for a maximum of two MDOI payments. For qualifying nursing facilities in the southwest Community HealthChoices (CHC) zone, the Department will use the nursing facility assessment quarterly resident day reporting forms available on October 31, 2019, for the July 1, 2017—September 30, 2017, Resident Day Quarter for the first payment and will use the nursing facility assessment quarterly resident day reporting forms available on January 31, 2020, for the October 1, 2017—December 31, 2017, Resident Day Quarter for the second payment. For qualifying nursing facilities in the southeast CHC zone, the Department will use the nursing facility assessment quarterly resident day reporting forms available on October 31, 2019, for the July 1, 2018—September 30, 2018, Resident Day Quarter for the first payment and will use the nursing facility assessment quarterly resident day reporting forms available on January 31, 2020, for the October 1, 2018—December 31, 2018, Resident Day Quarter for the second payment. For qualifying nursing facilities in the Lehigh/Capital, northwest and northeast CHC zone, the Department will use the nursing facility assessment quarterly resident day reporting forms available on October 31, 2019, for the April 1, 2019—June 30, 2019, Resident Day Quarter for the first payment and will use the nursing facility assessment quarterly resident day reporting forms available on January 31, 2020, for the July 1, 2019—September 30, 2019, Resident Day Quarter for the second payment. The Department will calculate each qualified nonpublic nursing facility's MDOI payments based on the following formula:
(i) A MDOI per diem for each of the two MDOI payments will be 1/2 of the total funds appropriated for the fiscal year divided by the Total PA MA days as reported by all qualifying nursing facilities for the applicable Resident Day Quarter.
(ii) Each MDOI per diem will then be multiplied by each qualified nursing facility's Total PA MA days, as reported, for the applicable Resident Day Quarter to determine its MDOI payment.
(iii) The State funds allocated for FY 2019-2020 are $16 million.
The Department will not retroactively revise an MDOI payment amount based on a nursing facility's late submission or revision of its report related to the previously listed dates. The Department may recoup payments based on an audit of a nursing facility's report.
The Department will submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS), which is a condition for the availability of the payment. If CMS approves the SPA, the Department will have the authority to make MDOI payments to nonpublic nursing facilities for FY 2019-2020.
Fiscal Impact
The fiscal impact of this change is estimated at $33.508 million ($16.000 million in State funds) for FY 2019-2020.
Public Comment
Interested persons are invited to submit written comments regarding these payments to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Marilyn Yocum, P.O. Box 8025, Harrisburg, PA 17105-8025. 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 Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
TERESA D. MILLER,
SecretaryFiscal Note: 14-NOT-1362. (1) General Fund; (2) Implementing Year 2019-20 is $16,000,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$850,149,000; 2017-18 Program—$1,099,000,000; 2016-17 Program—$1,082,000,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 19-1488. Filed for public inspection October 4, 2019, 9:00 a.m.]
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