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PA Bulletin, Doc. No. 17-1424


Managed Care Assessment Program

[47 Pa.B. 5112]
[Saturday, August 26, 2017]

 The Department of Human Services (Department) is announcing a proposed adjustment to the managed care assessment fixed fee effective January 1, 2018.


 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. See section 15 of the act of December 28, 2015 (P.L. 500, No. 92) (Act 92) (Article VIII-I of the Human Services Code (62 P.S. §§ 801-I—812-I)). The fixed fee assessed on MCOs is currently $15.07 per member month.

 Act 92 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 affords interested parties 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 3-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 $19.87 per member month effective January 1, 2018. 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 2017-2018 will be an additional $163.113 million in assessment revenue.

Public Comment

 Interested persons are invited to submit written comments regarding the proposed adjustment to the MCO assessment fixed fee to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered in the determination of the final adjusted MCO assessment fixed fee. 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).

Acting Secretary

Fiscal Note: 14-NOT-1178. (1) General Fund; (2) Implementing Year 2017-18 is -$1,214,000,000; (3) 1st Succeeding Year 2018-19 through 5th Succeeding Year 2022-23 are $0; (4) 2016-17 Program—$3,658,000,000; 2015-16 Program—$3,829,000,000; 2014-15 Program—$3,823,000,000; (7) Medical Assistance—Capitation; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 17-1424. Filed for public inspection August 25, 2017, 9:00 a.m.]

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