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PA Bulletin, Doc. No. 09-1036


Payment for Nursing Facility Services Provided by Nonpublic and County Nursing Facilities; Change in Methods and Standards of Setting Payment Rates

[39 Pa.B. 2900]
[Saturday, June 6, 2009]


   This notice is to announce that the Department of Public Welfare (Department) is proposing to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services provided by nonpublic and county nursing facilities beginning Fiscal Year (FY) 2009-2010.


   Act 52 of 2007 (Act 52) was enacted in Pennsylvania on July 20, 2007. Act 52, among other things, requires all Pennsylvania nursing facilities to electronically report health care-associated infection (HAI) data to the Department of Health (DOH) and the Patient Safety Authority (Authority). Act 52 also requires that, commencing July 1, 2008, each nursing facility shall pay the DOH an annual HAI surcharge on its licensing fee to provide sufficient revenues for the Authority to perform its responsibilities related to the Act. Act 52 specifies that the HAI surcharge fees for FY 2008-2009 shall not, in the aggregate, exceed $1,000,000 and that the total HAI surcharge amount in each succeeding FY will be increased according to the Consumer Price Index.

   Act 52 directs the Department to recognize the MA portion of the annual HAI surcharge paid by a nursing facility as an allowable cost under the MA Program. Contingent upon Federal approval the Department is directed to pay each nursing facility a separate pass-through payment in an amount equal to the HAI surcharge fee paid by a facility multiplied by the facility's MA occupancy rate as reported on its annual cost report.

   Beginning FY 2008-2009, the DOH assessed and collected the HAI surcharge from all nursing facilities. MA nursing facilities shall report the HAI surcharge on the cost report on line 33 of Schedule C for cost report periods beginning on or after January 1, 2008.

   The Department will submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) to seek Federal approval to make a HAI pass-through payment to MA nursing facilities to recognize the MA portion of the HAI surcharge. The HAI pass-through payment will be based on the nursing facility's MA occupancy rate as reported on the cost report in which the HAI surcharge is reported multiplied by the surcharge paid minus any penalties assessed by the DOH.

   The HAI pass-through payments will be made annually within 120 days after the submission of an acceptable cost report provided that payment will not be made before 210 days of the close of the nursing facility FY and DOH has received the HAI surcharge fee.

Fiscal Impact

   This change will result in an estimated cost of $0.717 million in total funds ($0.248 million in State funds) in FY 2009-2010.

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Long-Term Living, Attention Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. Comments received within 33 days of publication of this notice in the Pennsylvania Bulletin 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).


   Fiscal Note: 14-NOT-600. (1) General Fund; (2) Implementing Year 2009-10 is $248,000; (3) 1st Succeeding Year 2010-11 is $286,000; 2nd Succeeding Year 2011-12 is $327,000; 3rd Succeeding Year 2012-13 is $327,000; 4th Succeeding Year 2013-14 is $327,000; 5th Succeeding Year 2014-15 is $327,000; (4) 2007-08 Program--$692,585,000; 2006-07 Program--$695,279,000; 2005-06 Program--$817,890,000; (7) MA--Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 09-1036. Filed for public inspection June 5, 2009, 9:00 a.m.]

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