DEPARTMENT OF
PUBLIC WELFARECeilings on Net Operating Cost Reimbursement for General and County Nursing Facilities [26 Pa.B. 259] The Department of Public Welfare announces its ceilings on net operating reimbursement for general and county nursing facilities, the Metropolitan Statistical Area (MSA) or non-MSA classification levels and related information. The reimbursement ceilings and classification levels shall be effective for services rendered from July 1, 1995, through December 31, 1995.
The ceilings on allowable net operating costs established under this notice have been calculated as provided by 55 Pa. Code Chapter 1181 (16 Pa.B. 3294 (September 5, 1986)). Section 1181.66(a)(6) authorizes the Department of Public Welfare to announce these ceilings and classification levels by notice submitted for recommended publication in the Pennsylvania Bulletin and suggested codification in the Pennsylvania Code as an Annex to section 1181.66. Section 1181.66(a)(6) also requires that this notice be accompanied by a fiscal note prepared under section 612 of The Administrative Code of 1929 (71 P. S. § 232).
The reimbursement ceilings establish an upper limit of payment of the actual, allowable net operating costs of general and county nursing facilities. Each facility's most recent acceptable cost report that was on file with the Department by April 3, 1995, was incorporated into the data base that was used to establish the group ceilings.
Following is a listing by group of the number of facilities with a particular year-end and the inflation factor used to roll the costs of each facility forward to the common date of June 30, 1995.
GENERAL NURSING FACILITIES
(Excluding Hospital-Based and Special Rehabilitation Facilities)Facility Year End Number of Facilities Inflation Factor December 31, 1991 2 1.10 June 30, 1992 5 1.09 December 31, 1992 11 1.07 June 30, 1993 14 1.06 December 31, 1993 125 1.05 June 30, 1994 253 1.03 December 31, 1994 137 1.02 HOSPITAL-BASED NURSING FACILITIES Facility Year End Number of Facilities Inflation Factor June 30, 1992 1 1.09 June 30, 1993 3 1.06 June 30, 1994 23 1.03 SPECIAL REHABILITATION FACILITIES Facility Year End Number of Facilities Inflation Factor June 30, 1994 3 1.03 COUNTY NURSING FACILITIES Facility Year End Number of Facilities Inflation Factor December 31, 1993 16 1.05 December 31, 1994 28 1.02 After the net operating per diem costs of each facility were rolled forward to the common date of June 30, 1995, the Department used a 1.6% inflation factor to roll these costs forward to December 31, 1995. This percentile, per the DRI Health Care Costs--National Forecasts Individual Price and Wages Indexes, is the end point of the 6 months, from July 1, 1995, to December 31, 1995, at which time a new reimbursement system is scheduled to be in place.
After the data base is inflated using the above inflation values, the Department grouped the facilities in the correct geographic groupings. To determine 115% of the median net operating per diem cost, the Department first determined the median. The median net operating per diem cost is that net operating per diem cost at which an equal number of costs fall below and above that cost. To determine the median net operating per diem cost of a group with an odd number of arrayed costs, the Department chose the net operating per diem cost that had an equal number of costs both above and below that cost. For groups with an even number of arrayed net operating per diem costs, the Department took the two net operating per diem costs that were closest to the middle, then divided the total of these two costs by two to calculate the median net operating per diem cost of the group. Then the Department multiplied the median per diem cost of each group by 1.15.
The classification levels and ceilings on the net operating per diem costs of general and county nursing facilities effective July 1, 1995, are listed in Annex A.
The net operating cost reimbursement ceilings and classification levels for the general and county nursing facilities are hereby adopted as set forth in Annex A of this notice.
The Department estimates that the aggregate costs of these ceilings for July 1, 1995, through December 31, 1995 will be $15.269 million, of which $6.977 million is in State funds and $8.292 million in Federal funds.
Public comment on these changes may be sent to Connie L. Pretz, Medical Assistance Program Specialist, Department of Public Welfare, Division of Provider Services, Post Office Box 8025, Harrisburg, PA 17105.
FEATHER O. HOUSTOUN,
SecretaryANNEX A Annex to 55 Pa. Code § 1181.66 GENERAL NURSING FACILITIES
(Excluding Hospital-Based and Special Rehabilitation Facilities)*Skilled Nursing Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31, 1995*Intermediate
Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31,
19951. LEVEL A Philadelphia Bucks $133.39 $110.54 Chester $133.39 $110.54 Delaware $133.39 $110.54 Montgomery $133.39 $110.54 Philadelphia $133.39 $110.54 Pittsburgh Allegheny $133.39 $110.54 Beaver $133.39 $110.54 Butler $133.39 $110.54 Fayette $133.39 $110.54 Washington $133.39 $110.54 Westmoreland $133.39 $110.54 2. LEVEL B Allentown--Bethlehem--Easton Carbon $117.20 $ 98.00 Lehigh $117.20 $ 98.00 Northampton $117.20 $ 98.00 Erie Erie $117.20 $ 98.00 Harrisburg--Lebanon--Carlisle Cumberland $117.20 $ 98.00 Dauphin $117.20 $ 98.00 Lebanon $117.20 $ 98.00 Perry $117.20 $ 98.00 Lancaster Lancaster $117.20 $ 98.00 Newburgh Pike $117.20 $ 98.00 Reading Berks $117.20 $ 98.00 Scranton--Wilkes-Barre--Hazleton Columbia $117.20 $ 98.00 Lackawanna $117.20 $ 98.00 Luzerne $117.20 $ 98.00 Wyoming $117.20 $ 98.00 York York $117.20 $ 98.00 3. LEVEL C Altoona Blair $115.67 $ 91.37 Johnstown Cambria $115.67 $ 91.37 Somerset $115.67 $ 91.37 Sharon Mercer $115.67 $ 91.37 State College Centre $115.67 $ 91.37 Williamsport Lycoming $115.67 $ 91.37 4. Non-MSA Adams $105.51 $ 86.15 Armstrong $105.51 $ 86.15 Bedford $105.51 $ 86.15 Bradford $105.51 $ 86.15 Cameron $105.51 $ 86.15 Clarion $105.51 $ 86.15 Clearfield $105.51 $ 86.15 Clinton $105.51 $ 86.15 Crawford $105.51 $ 86.15 Elk $105.51 $ 86.15 Forest $105.51 $ 86.15 Franklin $105.51 $ 86.15 Fulton $105.51 $ 86.15 Greene $105.51 $ 86.15 Huntingdon $105.51 $ 86.15 Indiana $105.51 $ 86.15 Jefferson $105.51 $ 86.15 Juniata $105.51 $ 86.15 Lawrence $105.51 $ 86.15 McKean $105.51 $ 86.15 Mifflin $105.51 $ 86.15 Monroe $105.51 $ 86.15 Montour $105.51 $ 86.15 Northumberland $105.51 $ 86.15 Potter $105.51 $ 86.15 Schuylkill $105.51 $ 86.15 Snyder $105.51 $ 86.15 Sullivan $105.51 $ 86.15 Susquehanna $105.51 $ 86.15 Tioga $105.51 $ 86.15 Union $105.51 $ 86.15 Venango $105.51 $ 86.15 Warren $105.51 $ 86.15 Wayne $105.51 $ 86.15 *Does not include depreciation and interest. HOSPITAL-BASED NURSING FACILITIES *Skilled Nursing Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31, 1995*Intermediate Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31, 1995Statewide per diem ceilings $202.80 $135.08 *Does not include depreciation and interest. SPECIAL REHABILITATION FACILITIES
*Skilled Nursing Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31, 1995*Intermediate Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31, 1995Statewide
per diem
ceilings$310.29 $231.97 *Does not include depreciation and interest. COUNTY NURSING FACILITIES *Skilled Nursing Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31, 1995*Intermediate Care
Net Operating
Ceilings Effective
July 1, 1995 thru
December 31, 19951. LEVEL A and B Philadelphia Bucks $145.04 $125.96 Chester $145.04 $125.96 Delaware $145.04 $125.96 Montgomery $145.04 $125.96 Philadelphia $145.04 $125.96 Pittsburgh Allegheny $145.04 $125.96 Beaver $145.04 $125.96 Butler $145.04 $125.96 Fayette -- -- Washington $145.04 $125.96 Westmoreland $145.04 $125.96 Allentown--Bethlehem--Easton Carbon $145.04 $125.96 Lehigh $145.04 $125.96 Northampton $145.04 $125.96 Erie Erie $145.04 $125.96 Harrisburg--Lebanon--Carlisle Cumberland $145.04 $125.96 Dauphin $145.04 $125.96 Perry -- -- Lebanon $145.04 $125.96 Lancaster Lancaster $145.04 $125.96 Newburgh Pike -- -- Reading Berks $145.04 $125.96 Scranton--Wilkes-Barre--Hazleton Columbia -- -- Lackawanna $145.04 $125.96 Luzerne $145.04 $125.96 Wyoming -- -- York York $145.04 $125.96 2. LEVEL C and Non-MSA Altoona Blair $125.90 $103.12 Johnstown Cambria $125.90 $103.12 Somerset $125.90 $103.12 Sharon Mercer $125.90 $103.12 State College Centre $125.90 $103.12 Williamsport Lycoming -- -- All Non-MSA Adams $125.90 $103.12 Armstrong $125.90 $103.12 Bedford -- -- Bradford $125.90 $103.12 Cameron -- -- Clarion -- -- Clearfield -- -- Clinton $125.90 $103.12 Crawford $125.90 $103.12 Elk -- -- Forest -- -- Franklin $125.90 $103.12 Fulton -- -- Greene $125.90 $103.12 Huntingdon -- -- Indiana $125.90 $103.12 Jefferson -- -- Juniata -- -- Lawrence $125.90 $103.12 McKean $125.90 $103.12 Mifflin -- -- Monroe $125.90 $103.12 Montour -- -- Northumberland$125.90 $103.12 Potter -- -- Schuylkill $125.90 $103.12 Snyder -- -- Sullivan -- -- Susquehanna -- -- Tioga -- -- Union -- -- Venango $125.90 $103.12 Warren $125.90 $103.12 Wayne -- -- *Does not include depreciation and interest.
Fiscal Note: 14-NOT-103. (1) General Fund; (2) Implementing year 1995-96 is $6,977,000; (3) 1st succeeding year 1996-97 is $-0-; 2nd succeeding year 1997-98 is $-0-; 3rd succeeding year 1998-99 is $-0-; 4th succeeding year 1999-00 is $-0-; 5th succeeding year 2000-01 is $-0-; (4) FY 1994-95 is $593,822,000; FY 1993-94 is $493,275,000;FY 1992-93 is $463,007,000; (7) Medical Assistance-Long Term Care; (8) recommends adoption.
[Pa.B. Doc. No. 96-80. Filed for public inspection January 19, 1996, 9:00 a.m.]
