NOTICES
DEPARTMENT OF
HUMAN SERVICES
Payments to Nonpublic and County Nursing Facilities; Final Rates for State Fiscal Year 2019-2020
[50 Pa.B. 263]
[Saturday, January 11, 2020]This notice announces the Department of Human Services (Department) final annual case-mix per diem payment rates for State Fiscal Year (FY) 2019-2020 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 each quarter of FY 2019-2020, the Department will adjust the resident care component of each facility's rate by multiplying the resident care component by the facility's MA case-mix index for the appropriate picture date.
The Centers for Medicare & Medicaid Services (CMS) approved State Plan Amendment (SPA) 19-0017 on October 28, 2019, which includes the budget adjustment factor (BAF) formula the Department will use for nonpublic nursing facilities in FY 2019-2020. SPA 19-0017 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 2019-2020, 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 stated 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 19-0018 on October 28, 2019, which includes the BAF formula the Department used for county nursing facilities in FY 2019-2020.
SPA 19-0018 provides that for rate setting year 2019-2020, 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. The BAF as it applies to county nursing facilities is 1.0.
The final annual per diem rates for FY 2019-2020 rate year are available on the Department's web site at http://www.dhs.pa.gov/providers/Providers/Pages/Long-Term-Nursing-Facilities.aspx and at local county assistance offices (CAO) throughout this Commonwealth or by contacting Marilyn Yocum, Department of Human Services, Office of Long-Term Living at (717) 772-2549. As they become available, the adjusted quarterly rates will be accessible on the Department's web site, at CAOs or by contacting Marilyn Yocum.
Public Process
The Department published the notice Payment for Nursing Facility Services Provided by County and Nonpublic Nursing Facilities; Notice of Change in Methods and Standards of Setting Payment Rates; Budget Adjustment Factor at 49 Pa.B. 3414 (June 29, 2019) announcing the proposed change in the BAF formula for county and nonpublic nursing facilities. The Department also published a second notice, Payments to Nonpublic and County Nursing Facilities; Proposed Rates for State Fiscal Year 2019-2020, at 49 Pa.B. 3416 (June 29, 2019) announcing that the FY 2019-2020 quarterly BAF that will be applied to nonpublic nursing facility rates and the annual BAF that will be applied to county nursing facilities rates are available on the Department's web site. Both notices invited public comments, and the Department received no comments.
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 2019-2020. 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 2019-2020. A provider's appeal must be in writing and filed with the Department's Bureau of Hearings and Appeals, 2330 Vartan Way, 2nd 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
There is no fiscal impact associated with this change.
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: Marilyn Yocum, P.O. Box 8025, Harrisburg, PA 17105-8025. 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 AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
TERESA D. MILLER,
SecretaryFiscal Note: 14-NOT-1377. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 20-48. Filed for public inspection January 10, 2020, 9:00 a.m.]
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