§ 1187.108. Gross adjustments to nursing facility payments.
(a) The case-mix payment system is a prospective system. There is no cost settlement under the case-mix payment system.
(b) Certain adjustments may be made which increase or decrease the payment which a nursing facility may have otherwise received. Gross adjustments to nursing facility payments are based on one or more of the following general provisions:
(1) If audit findings result in changing the peer group median and the peer group price, a retrospective gross adjustment is made for each nursing facility in the peer group where the change occurred.
(2) If a nursing facility’s MA CMI changes as a result of UMR resident assessment audit adjustments, retrospective gross adjustments shall be made for the nursing facility involved.
(c) Specific adjustments of the gross payments received by a nursing facility may be required by § § 1187.109—1187.115.
Cross References This section cited in 55 Pa. Code § 1187.141 (relating to nursing facility’s right to appeal and to a hearing).
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