DEPARTMENT OF PUBLIC WELFARE [55 PA. CODE CH. 1187] Disproportionate Share Incentive Payments [31 Pa.B. 6046] The Department of Public Welfare (Department), Office of Medical Assistance Programs, by this order adopts amendments to § 1187.111 (relating to disproportionate share incentive payments). The amendment is set forth in Annex A and is adopted under the authority of section 201(2) of the Public Welfare Code (62 P. S. § 201(2)) (act).
Notice of proposed rulemaking is omitted in accordance with section 204(1)(iv) and (3) of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. § 1204(1)(iv) and (3)) (CDL) and 1 Pa. Code § 7.4(1)(iv) and (3). Those provisions provide that an agency may omit notice of proposed rulemaking when the amendment relates to Commonwealth grants or benefits or where circumstances render it impractical, unnecessary or contrary to public interest. Notice of proposed rulemaking is omitted since this regulatory amendment involves an increase to Medical Assistance (MA) payments to qualifying nursing facilities that are already aware of this change.
Purpose of the Amendment
This amendment will increase the disproportionate share incentive payments to qualified nursing facilities effective for the periods January 1, 2000, through June 30, 2003, only. The disproportionate share incentive payment shall be increased to equal two times the disproportionate share per diem incentive calculated in accordance with § 1187.111(c).
Need for the Amendment
A disproportionate share incentive payment is made to MA participating nursing facilities having an annual overall occupancy rate of at least 90% of the total available bed days and an MA occupancy rate of at least 80% based on MA paid days of care times the per diem incentive to facilities.
The Intergovernmental Transfer (IGT) Agreement for Fiscal Year 1999-2000 provides that for the period January 1, 2000, to June 30, 2003, the disproportionate share incentive payment to qualified nursing facilities shall be increased to equal two times the disproportionate share per diem incentive calculated in accordance with § 1187.111(c).
Requirements
Section 1187.111 is being amended to provide increased disproportionate share incentive payments effective for the periods January 1, 2000, to June 30, 2003.
Affected Organizations
MA participating nursing facilities which have an annual overall occupancy rate of at least 90% of the total available bed days, and an MA occupancy rate of at least 80%, are eligible to receive disproportionate share incentive payments.
Fiscal Impact
Public Sector The Commonwealth
The Department will see an increase in moneys being paid to eligible nursing facilities due to doubling the disproportionate share incentive payments for the periods January 1, 2000, to June 30, 2003.
Political Subdivisions
No impact is anticipated.
Private Sector No impact is anticipated.
General Public No impact is anticipated.
Paperwork Requirements
There should be no increase in paperwork requirements.
Effective Date
This amendment shall take effect on January 1, 2000.
Sunset Date
There is no sunset date for this section.
Public Comments
Although this section is being adopted without prior notice, interested persons are invited to submit their written comments within 30 days from the date of this publication for consideration by the Department as to whether the amendment should be revised. The comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, Attention: Regulations Coordinator, Room 515 Health and Welfare Building, Harrisburg, PA 17105.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (Voice users). Persons who require another alternative should contact Tom Vracarich in the Office of Legal Counsel at (717) 783-2209.
Regulatory Review
Under section 5.1(c) of the Regulatory Review Act (71 P. S. § 745.5a(c)), on September 4, 2001, the Department submitted a copy of this amendment with proposed rulemaking omitted on to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House Committee on Health and Human Services and the Senate Committee on Public Health and Welfare. On the same date, the final-omitted regulation was submitted to the Office of the Attorney General for review and approval under the Commonwealth Attorneys Act (71 P. S. §§ 732-101--732-506)
Under section 5.1(d) of the Regulatory Review Act, on September 24, 2001, this final-omitted regulation was deemed approved by the Committees. Under section 5.1(e) of the Regulatory Review Act, on October 18, 2001, IRRC met and approved the final-omitted regulation.
Findings
The Department finds that:
(1) Notice of proposed rulemaking is omitted because this regulation relates to Commonwealth grants and benefits and notice of proposed rulemaking is unnecessary and contrary to the public interest under section 204(1)(iv) and (3) of the CDL and 1 Pa. Code § 7.4(1)(iv) and (3).
(2) The adoption of this final-omitted regulation in the manner provided in this order is necessary and appropriate for the administration and enforcement of the act.
Order
The Department, acting under the authority of the act, orders that:
(a) The regulations of the Department, 55 Pa.Code Chapter 1187, are amended by amending § 1187.111 to read as set forth in Annex A.
(b) The Secretary of the Department shall submit this order and Annex A to the Attorney General and General Counsel for approval as to legality and form as required by law.
(c) The Secretary of the Department shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect on January 1, 2000.
FEATHER O. HOUSTOUN,
Secretary(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 31 Pa.B. 6120 (November 3, 2001).)
Fiscal Note: 14-470 (1) Increased program costs to the General Fund. There will be increased program costs to the State. (2) Implementing Year 2000-01 is $4,999,000; (3) 1st Succeeding Year 2001-02 is $5,084,000; 2nd Succeeding Year 2002-03 is $5,222,000; 3rd Succeeding Year 2003-04 is $2,697,000; (4) 1999-00 Program--$793,246,000; 1998-99 Program--$693,625,000; 1997-98 Program--$721,631,000; (7) MA--Long Term Care; (8) recommends adoption. Costs are budgeted into the MA--Long Term Care appropriation.
Annex A TITLE 55. PUBLIC WELFARE PART III. MEDICAL ASSISTANCE MANUAL CHAPTER 1187. NURSING FACILITY SERVICES Subchapter H. PAYMENT CONDITIONS, LIMITATIONS AND ADJUSTMENTS § 1187.111. Disproportionate share incentive payments.
(a) A disproportionate share incentive payment will be made based on MA paid days of care times the per diem incentive to facilities meeting the following criteria for a 12-month facility cost reporting period:
(1) The nursing facility shall have an annual overall occupancy rate of at least 90% of the total available bed days.
(2) The nursing facility shall have an MA occupancy rate of at least 80%. The MA occupancy rate is calculated by dividing the MA days of care paid by the Department by the total actual days of care.
(b) The disproportionate share incentive payments will be based on the following for year 1 of implementation:
Overall Occupancy MA
Occupancy
(y)
Per Diem Incentive Group A 90% >= 90% y $2.50 Group B 90% 88%<> y <=90%> $1.70 Group C 90% 86%<> y <=88%> $1.00 Group D 90% 84%<> y <=86%> $0.60 Group E 90% 82%<> y <=84%> $0.30 Group F 90% 80%<> y <=82%> $0.20 (c) For each year subsequent to year 1 of implementation, disproportionate share incentive payments as described in subsection (b) will be inflated forward using the Health Care Financing Administration Nursing Home Without Capital Market Basket Index to the end point of the rate setting year for which the payments are made.
(d) These payments will be made annually within 120 days after the submission of an acceptable cost report provided that payment will not be made before 210 days of the close of the nursing facility fiscal year.
(e) For year 1 of implementation only, facilities with a June 30 cost report year end will receive a disproportionate share payment based on the January 1 through June 30 time period.
(f) For the period January 1, 2000, to June 30, 2003, the disproportionate share incentive payment to qualified nursing facilities shall be increased to equal two times the disproportionate share per diem incentive calculated in accordance with § 1187.111(c).
(1) For the period commencing January 1, 2000, through June 30, 2000, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 1999, or June 30, 2000.
(2) For the period commencing July 1, 2000, through June 30, 2001, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 2000, or June 30, 2001.
(3) For the period commencing July 1, 2001, through June 30, 2002, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 2001, or June 30, 2002.
(4) For the period commencing July 1, 2002, through June 30, 2003, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 2002, or June 30, 2003.
[Pa.B. Doc. No. 01-1958. Filed for public inspection November 2, 2001, 9:00 a.m.]
