49 Payments to nonpublic and county nursing facilities; final rates for State fiscal year 2009-2010?

DEPARTMENT OF
PUBLIC WELFARE

Payments to Nonpublic and County Nursing Facilities; Final Rates for State Fiscal Year 2009-2010

[41 Pa.B. 307]
[Saturday, January 8, 2011]

 This notice announces the Department of Public Welfare's (Department) final annual case-mix per diem payment rates for State Fiscal Year (FY) 2009-2010 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 set forth in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department annually sets an 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.

 The act of July 4, 2008 (P. L. 557, No. 44) (Act 44), among other things, directed the Department to apply a budget adjustment factor (BAF) in calculating rates for MA nonpublic and county nursing facilities over a 3-year period, beginning July 1, 2008, and ending June 30, 2011, and to phase-out the use of county nursing facility costs in nonpublic nursing facility rate setting over a period of 3-rate years, beginning FY 2009-2010 and ending on June 30, 2012. The Department will continue to include county nursing facilities in determining peer groups in accordance with 55 Pa. Code § 1187.94(1)(v) (relating to peer grouping for price setting) for rate years 2009-2010, 2010-2011 and 2011-2012. Once peer groups have been determined, the Department will calculate an interim median by adding each county nursing facility's costs from the three most recent audited cost reports to a noncollapsed peer group based on bed size and Metropolitan Statistical Area group. For rate year 2009-2010, the phase-out median will equal 75% of the interim median plus 25% of the median calculated in accordance with 55 Pa. Code § 1187.98(b)(2) (relating to phase-out median determination).

 The Federal Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 09-018 on September 22, 2010. SPA 09-018 states that the BAF for rate setting year 2009-2010 shall limit the estimated aggregate change in the Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the aggregate percentage rate of increase for the period that begins July 1, 2009, and ends on June 30, 2010, is limited to the amount permitted by the funds appropriated by the General Appropriations Act of 2009. For the rate setting year, beginning July 1, 2009, and ending June 30, 2010, the BAF for nonpublic nursing facilities is equal to 0.90275.

County Nursing Facility Per Diem Rates

 As required by the rate methodology set forth 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 rate multiplied by a BAF.

 In addition, as required by 55 Pa. Code § 1189.91(d), the Department followed the formula set forth in the Commonwealth's approved State Plan to determine that the BAF for FY 2009-2010 for county nursing facilities is 1.01. CMS approved State Plan Amendment 09-017 on September 22, 2010.

 SPA 09-017 states that for rate setting year 2009-2010 and 2010-2011, the BAF shall limit the estimated aggregate increase in the Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the aggregate percentage rate of increase for the period that begins July 1, 2005, and ends on June 30, 2011, is limited to the amount permitted by the funds appropriated by the General Appropriations Acts. The formula for this BAF as it applies to county nursing facilities is BAF = 1.00 + 0.01.

 The final annual per diem rates for FY 2009-2010 are available on the web site for the Department at: www.dpw.state.pa.us/provider/doingbusiness withdpw/longtermcarecasemixinformation/index.htm and at local county assistance offices throughout this Commonwealth or by contacting Marilyn Yocum, Department of Public Welfare, Office of Long-Term Living at [phone].

Public Process

 The Department published a notice in the Pennsylvania Bulletin announcing its proposed case-mix per diem payment rates for nonpublic and county nursing facilities for FY 2009-2010 at 40 Pa.B. 3629 (June 26, 2010) and invited interested persons to submit comments. No comments were received by the Department in response to the proposed rate notice.

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 2009-2010. 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 2009-2010. 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 at 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

 The change in payment rates, will result in an estimated increased cost of $24.433 million ($8.360 million in State funds) for per diem rate payments to nonpublic nursing facilities and an estimated increased cost of $5.539 million ($1.895 million in State funds) for per diem rate payments for county nursing facilities' FY 2009-2010 rates compared to the facilities' final FY 2008-2009 per diem rates. Funding for these changes has been included in the MA Long-Term Care appropriation.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare/Department of Aging, Office of Long-Term Living, Bureau of Policy and Strategic Planning, Attention: Marilyn Yocum, Forum Place, 5th Floor, 555 Walnut Street, Harrisburg, PA 17101-1919. 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 [phone] (TDD users) or [phone] (voice users).

MICHAEL P. NARDONE, 
Acting Secretary

 Fiscal Note: 14-NOT-677. (1) General Fund; (2) Implementing Year 2009-10 is $10,255,000; 1st Succeeding Year 2010-11 is $10,255,000; 2nd Succeeding Year 2011-12 is $10,255,000; 3rd Succeeding Year 2012-13 is $10,255,000; 4th Succeeding Year 2013-14 is $10,255,000; 5th Succeeding Year 2014-15 is $10,255,000; (4) 2008-09 Program—$672,597,000; 2007-08 Program—$692,585,000; 2006-07 Program—$695,297,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 11-49. Filed for public inspection January 7, 2011, 9:00 a.m.]