NOTICES

DEPARTMENT OF
HUMAN SERVICES

Managed Care Assessment Program

[54 Pa.B. 6345]
[Saturday, October 5, 2024]

 The Department of Human Services (Department) is announcing a proposed adjustment to the managed care assessment fixed fee effective January 1, 2025.

Background

 In 2015, the General Assembly enacted legislation authorizing the Department to impose an annual monetary assessment on managed care organizations (MCO) in this Commonwealth for 4 years beginning in State Fiscal Year (FY) 2016-2017. In 2020 the General Assembly enacted legislation to continue the assessment through June 30, 2025. See section 1601-O of the Fiscal Code (72 P.S. § 1601-0), as amended by the act of May 29, 2020 (P.L. 158, No. 23) (Act 23). The fixed fee assessed on MCOs is currently $24.95 per member month.

 Article VIII-I of the Human Services Code (62 P.S. §§ 801-I—812-I) authorizes the Secretary of Human Services (Secretary) to adjust the assessment fixed fee for all or part of a fiscal year so long as the assessment does not exceed the Federal maximum 6% limit of revenue specified in 42 CFR 433.68(f)(3)(i)(A) (relating to permissible health care-related taxes). Before adjusting the assessment percentage, the Secretary must publish a notice in the Pennsylvania Bulletin that specifies the proposed adjusted assessment fixed fee, identifies the aggregate impact on MCOs subject to the assessment and provides interested parties with 30 days to comment. After consideration of any comments received during the 30-day period, the Secretary must publish a second notice announcing the adjusted assessment fixed fee. See section 803-I(c) of the Human Services Code (62 P.S. § 803-I(c)).

Proposed Adjusted Assessment Fixed Fee

 The Department is proposing to adjust the MCO assessment fixed fee to $30.47 per member month effective January 1, 2025. The proposed adjusted assessment fixed fee will not exceed the Federal maximum limit of 6% of revenue.

Fiscal Impact

 The Department estimates that the aggregate fiscal impact for this change in FY 2024-2025 will be an additional $223.531 million in assessment revenue.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or to RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered in determining the final payment methodology for these payments.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

VALERIE A. ARKOOSH, 
Secretary

 Fiscal Note: 14-NOT-1655. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund;

 (7) Medical Assistance (MA)—Capitation; (2) Implementing Year 2024-25 is -$215,690,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are -$431,381,000; (4) 2023-24 Program—$3,594,000,000; 2022-23 Program—$3,418,000,000; 2021-22 Program—$4,557,000,000;

 (7) MA—Community HealthChoices; (2) Implementing Year 2024-25 is -$6,138,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are -$12,276,000; (4) 2023-24 Program—$5,282,000,000; 2022-23 Program—$4,460,000,000; 2021-22 Program—$4,252,000,000;

 (7) CHIP; (2) Implementing Year 2024-25 is -$1,703,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are -$3,408,000; (4) 2023-24 Program—$110,957,000; 2022-23 Program—$75,561,000; 2021-22 Program—$46,374,000;

 (8) recommends adoption. The enacted budget is reflective of the fee adjustment.

[Pa.B. Doc. No. 24-1432. Filed for public inspection October 4, 2024, 9:00 a.m.]

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