Nursing Facility Assessment Program [38 Pa.B. 5506]
[Saturday, October 4, 2008]This notice announces the proposed assessment amount, the proposed assessment methodology and the estimated aggregate impact on nursing facilities that will be subject to the assessment under the Nursing Facility Assessment Program (Assessment Program) in Fiscal Year (FY) 2008-2009.
Background
In 2003, the Pennsylvania General Assembly amended the Public Welfare Code to authorize the Department of Public Welfare (Department) to implement a monetary assessment on private nursing facilities in this Commonwealth over a 4 year period beginning July 1, 2003, and ending June 30, 2007. Act of September 30, 2003 (P. L. 169, No. 25) (Act 25), codified at 62 P. S. §§ 801-A--815-A. Since the implementation of the Assessment Program, the Department used the Assessment Program revenue to maintain and augment payments to Pennsylvania's Medical Assistance (MA) nursing facility providers. Recognizing the substantial benefits realized through the Assessment Program, the General Assembly enacted Act 16 of 2007 to reauthorize the Assessment Program for an additional 5 years. Act of June 30, 2007 (P. L. 169, No. 16) (Act 16). In addition to reauthorizing the Assessment Program, Act 16 amended the Public Welfare Code to allow the Department to include county nursing facilities in the Assessment Program effective July 1, 2007. Id., 62 P. S. § 802-A. For FY 2007-2008, the Department exercised its discretion to include the county nursing facilities in the Assessment Program.
For each fiscal year that the Assessment Program is implemented, the Secretary of the Department (Secretary), in consultation with the Secretary of the Budget, must determine the aggregate amount of the assessment and the annual assessment rate. The aggregate amount and rate of assessment must be approved by the Governor's Office. The annual assessment rates must be sufficient to generate at least $50 million in additional revenue, subject to the maximum aggregate assessment amount that qualifies for Federal matching funds. See section 804-A of Act 25 (62 P. S. § 804-A).
Before implementing the Assessment Program in a fiscal year, the Secretary must publish a notice in the Pennsylvania Bulletin that specifies the amount of the assessment being proposed, provides an explanation of the assessment methodology and assessment amount, and identifies the aggregate impact on nursing facilities subject to the assessment. See section 805-A of Act 25 (62 P. S. § 805-A).
Additionally, the Department must seek approval from the Federal Centers for Medicare and Medicaid Services (CMS) to implement the Assessment Program in conformity with Federal law and to guarantee that the assessment amounts qualify for matching Federal funds. See 62 P. S. § 812-A. To assure that revenues generated from the Assessment Program qualify for Federal matching funds, the Department submitted a request to CMS for an amendment to the Assessment Program for FY 2008-2009. The implementation of the changes to the Assessment Program is contingent on CMS's approval of the request.
This notice announces the assessment amounts, rates, and methodology that the Department is proposing to implement in FY 2008-2009 and the estimated aggregate impact on nursing facilities that will be subject to the assessment in FY 2008-2009.
Proposed Assessment Methodology and Rates
During FY 2008-2009, the Department is proposing to maintain the same assessment methodology that was used in FY 2007-2008.
The following nursing facilities will continue to be exempt from the Assessment Program in FY 2008-2009:
(1) State owned and operated nursing facilities.
(2) Veteran's Administration nursing facilities.
(3) Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter in which an assessment is collected.
(4) Nursing facilities that provide nursing facility services free of charge to all residents.
Under the proposed rate structure, the Department will continue to assess nonexempt nursing facilities at two rates. One rate will apply to county nursing facilities, to facilities that have 50 or fewer beds, and to nursing facilities that participate in a continuing care retirement community (CCRC). The other rate will apply to all other nonexempt facilities. Each nonexempt facility's quarterly assessment amount will continue to be calculated by multiplying its assessment rate by the facility's non-Medicare resident days during the calendar quarter that immediately precedes the assessment quarter.
Although the Department intends to maintain the same basic rate structure for FY 2008-2009, the Department is proposing to decrease the assessment rates for nonexempt nursing facilities from FY 2007-2008. Specifically, the Department proposes to implement the following assessment rates during FY 2008-2009:
(1) The proposed assessment rate for county nursing facilities and for nonexempt facilities that either have 50 or fewer beds or participate in a CCRC will be $2.30 per non-Medicare resident day.
(2) The proposed assessment rate for all other nonexempt nursing facilities will be $23.75 per non-Medicare resident day.
Aggregate Assessment Amounts and Fiscal Impact
The Department estimates that, if the proposed assessment rates are implemented, the annual aggregate assessment fees for nonexempt nursing facilities will total $378,315 million for FY 2008-2009. The Department will use the State revenue derived from the assessment fees and any associated Federal matching funds to maintain and increase payments to qualified MA nursing facility providers in accordance with applicable law and regulations.
Public Comment
Interested persons are invited to submit written comments regarding the contents of this notice to Gail Weidman, Department of Public Welfare, Office of Long-Term Living, P. O. Box 2675, Harrisburg, PA 17105. Comments must be submitted within 30 days of publication of the notice. See 62 P. S. § 805-A. After considering the comments, the Secretary will publish a second notice announcing the final assessment rates for FY 2008-2009. The Department will not begin collecting assessment fees until after the publication of the final assessment rate notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-569. No fiscal impact; (8) recommends adoption. Enactment of this regulation is expected to generate $283.736 million in State revenue.
[Pa.B. Doc. No. 08-1816. Filed for public inspection October 3, 2008, 9:00 a.m.]
