NOTICES
DEPARTMENT OF
HUMAN SERVICES
Payments to Nonpublic and County Nursing Facilities; Final Rates for State Fiscal Year 2023-2024
[54 Pa.B. 2428]
[Saturday, May 4, 2024]This notice announces the Department of Human Services (Department) final annual case-mix per diem payment rates for State Fiscal Year (FY) 2023-2024 for nonpublic and county nursing facilities that participate in the Medical Assistance (MA) Program.
Nonpublic Nursing Facility Per Diem Rates
As required by the case-mix payment methodology in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department sets an annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate is comprised of four components: resident care, other resident related, administrative and capital. For FY 2023-2024, the Department shall calculate each nursing facility's case-mix rate based on the cost database and peer group prices for each net operating cost center used in the calculation of each nursing facility's case-mix rates for FY 2022-2023. Each nursing facility's case-mix rate shall be adjusted quarterly in accordance with 55 Pa. Code § 1187.96(a)(5) (relating to price- and rate-setting computations).
The Centers for Medicare & Medicaid Services (CMS) approved State Plan Amendment (SPA) 22-0023 on November 23, 2022, which includes the budget adjustment factor (BAF) formula the Department will use for nonpublic nursing facilities in FY 2023-2024.1 SPA 22-0023 provides that the BAF will limit the estimated Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the average payment rate in effect for the fiscal year is limited to the amount permitted by the funds appropriated by the General Appropriations Act for the fiscal year. For FY 2023-2024, the Department will calculate a BAF for nonpublic nursing facilities for each rate quarter. The formula the Department uses to determine the quarterly BAF equals the annual target rate divided by the weighted average quarterly rate at 100%. If the quarterly BAF as calculated is greater than 1.0, the quarterly BAF will equal 1.0. The quarterly BAF for each calendar quarter will be in the rate file that will be posted on the Department's web site.
County Nursing Facility Per Diem Rates
As required by the rate methodology in 55 Pa. Code Chapter 1189, Subchapter D (relating to rate setting), the Department sets an annual MA per diem rate for each county nursing facility provider. As specified in 55 Pa. Code § 1189.91(b) (relating to per diem rates for county nursing facilities), for each rate year beginning on or after July 1, 2007, the per diem rate paid to a county nursing facility for a rate year will be the facility's prior rate year per diem multiplied by a BAF.
In addition, as required by 55 Pa. Code § 1189.91(d), the Department used the formula set forth in the Commonwealth's approved State Plan to determine the BAF for county nursing facilities. CMS approved SPA 22-0024 on November 23, 2022, which includes the BAF formula the Department used for county nursing facilities in FY 2023-2024.
SPA 22-0024 provides that for rate setting year 2023-2024, the BAF shall limit the estimated Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the average payment rate is limited to the amount permitted by the funds appropriated by the General Appropriations Act.2 The BAF as it applies to county nursing facilities is 1.0.
The final annual per diem rates for FY 2023-2024 rate year are available on the Department's web site at https://www.dhs.pa.gov/providers/Providers/Pages/Rates-Nursing%20Facilites.aspx and at local county assistance offices throughout this Commonwealth.
Public Process
The Department published the notice Payments to Nonpublic and County Nursing Facilities; Proposed Rates for State Fiscal Year 2023-2024 at 53 Pa.B. 3385 (June 24, 2023) announcing the proposed annual per diem rates for nonpublic and county nursing facilities for FY 2023-2024. The notice invited public comments. Three public comments were received about the proposed rates for nonpublic nursing facilities. Commentators were concerned about the variability and volatility of the proposed rates and recommended the Department implement an alternate rate setting methodology. In response, the General Assembly enacted legislation which addressed the commentators' concerns (Act of October 23, 2023, Pub.L. 63, No. 15) and which the Department implements in its final rates for nonpublic nursing facilities for FY 2023-2024 with this 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 2023-2024. 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 2023-2024. A provider's appeal must be in writing and filed with the Department's Bureau of Hearings and Appeals, 2330 Vartan Way, Second Floor, Harrisburg, PA 17110-9721, 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 in 55 Pa. Code Chapter 41 (relating to Medical Assistance provider appeal procedures), for more detail regarding their appeal rights and the requirements related to written appeals.
Fiscal Impact
For FY 2023-2024, the change in payment rates will result in an estimated cost of $2.830 million ($1.298 million in State funds) for per diem rate payments to nonpublic nursing facilities and an estimated cost of $0.237 million ($0.109 million in State funds) for per diem rate payments for county nursing facilities. Funding for these changes has been included in the MA Long-Term Living appropriation.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Robyn Kokus, P.O. Box 8025, Harrisburg, PA 17105-8025 or at RA-PWOLTLNFPUBLICCOM@pa.gov. 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 Hamilton Relay Service by dialing 711 or by using one of the toll-free numbers: (800) 654-5984 (TDD users), (800) 654-5988 (voice users), (844) 308-9292 (Speech-to-Speech) or (844) 308-9291 (Spanish).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1625. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2023-24 is $1,407,000; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $0; (4) 2022-23 Program—$131,981,000; 2021-22 Program—$121,346,000; 2020-21 Program—$208,841,000; (7) MA—Long-Term Living; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 24-622. Filed for public inspection May 3, 2024, 9:00 a.m.] _______
1 SPA 22-0023 approved the continued use of the BAF for nonpublic nursing facility payment rates for the 2022-2023 through 2025-2026 rate years.
2 SPA 22-0024 approved the continued use of the BAF for county nursing facility payment rates for the 2022-2023 through 2025-2026 rate years.
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