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PA Bulletin, Doc. No. 03-107


Payments to Nursing Facilities; October 1, 2002 Final Rates

[33 Pa.B. 441]

   This notice announces final nursing facility per diem payment rates based on case-mix index (CMI) adjustments only, for nursing facility services provided on or after October 1, 2002, in accordance with section 1902(a)(13)(A) of the Social Security Act (42 U.S.C.A. § 1902(a)(13)(A)), as amended by section 4711 of the Balanced Budget Act of 1997 (Pub. L. No. 105-33). On October 1, 2002, proposed rates notice was published at 32 Pa.B. 5481 (November 2, 2002), and provided for a 30-day comment period. The Department of Public Welfare (Department) did not receive any comments on the proposed October 1, 2002, rate notice.


   The final October 1, 2002, rates are available at the local county assistance offices throughout this Commonwealth, on the Office of Medical Assistance Programs' website at or by contacting Tom Jayson, Policy Unit, Bureau of Long Term Care Programs, (717) 705-3705.


   The methodology that the Department used to set the final rates based on CMI adjustments is contained in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting) and the Commonwealth's approved Title XIX State Plan.


   The justification for establishing the final rates is that the regulations at 55 Pa. Code Chapter 1187 (relating to nursing facility services) and the Commonwealth's approved Title XIX State Plan require that rates be set on a quarterly basis.


   On December 12, 2002, the Department sent each Medical Assistance nursing facility provider a proposed Certification and Settlement Agreement for Year 8 (July 1, 2002--June 30, 2003). A provider that does not sign that agreement may file an administrative appeal if it believes that the Department made any errors in computing or if it otherwise disagrees with its final rate. A provider's appeal must be in writing, sent to the Department's Bureau of Hearings and Appeals, P. O. Box 2675, Harrisburg, PA 17102, and received by the Bureau of Hearings and Appeals within 30 days of the date of the Department's letter notifying the provider of its final rates. The filing of an appeal constitutes the exclusive way by which a provider can present the Department with a demand that a final rate be modified, reversed, rescinded or otherwise altered, or with a demand that the Department increase the amount of reimbursement paid to the provider under that rate. If a provider chooses to appeal, the provider will be afforded the opportunity for a de novo hearing before the Bureau of Hearings and Appeals. The provider's rates may be changed as a result of the final adjudication of the appeal. Providers should refer to 55 Pa. Code § 1187.141 (relating to nursing facility's right to appeal and to a hearing) for more detail regarding their appeal rights and the requirements related to their written appeals.

   The estimated increase in annual aggregate expenditures for Medical Assistance nursing facility services for FY 2002-2003 based on these final rates is $12.257 million ($5.555 million in State funds).

   Interested persons are invited to submit written comments about the final rates to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin. Comments should be addressed to Department of Public Welfare, Office of Medical Assistance Programs, Attention: Suzanne Love, P. O. Box 2675, Harrisburg, PA 17105.

   Persons with a disability may use the AT&T Relay Services by calling (800) 654-5984 (TDD Users) or (800) 654-5988 (Voice Users).


   Fiscal Note: 14-NOT-346. (1) General Fund; (2) Implementing Year 2002-03 is $5,555,000; (3) 1st Succeeding Year 2003-04 is $8,363,000; 2nd Succeeding Year 2004-05 is $8,363,000; 3rd Succeeding Year 2005-06 is $8,363,000; 4th Succeeding Year 2006-07 is $8,363,000; 5th Succeeding Year 2007-08 is $8,363,000; (4) 2001-02 Program--$761,877,000; 2000-01 Program--$722,565,000; 1999-00--$693,625,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. Funding for these changes is included in the 2002-03 budget.

[Pa.B. Doc. No. 03-107. Filed for public inspection January 17, 2003, 9:00 a.m.]

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