DEPARTMENT OF PUBLIC WELFARE [55 PA. CODE CH. 1187] Principles for Rate and Price Setting [31 Pa.B. 6048] The Department of Public Welfare (Department), Office of Medical Assistance Programs, by this order adopts an amendment to § 1187.95 (relating to general principles for rate and price setting). 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)).
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). Section 204(1)(iv) and (3) of the CDL and § 7.4(1)(iv) and (3) provide that an agency may omit notice of proposed rulemaking when the amendment relates to Commonwealth grants or benefits or when circumstances render it impractical, unnecessary or contrary to public interest.
Purpose of Amendment
This amendment will extend the time frame for transition payments to county nursing facilities for the period January 1, 1999, to June 30, 2003, only. The transition payments concern Commonwealth benefits to Medical Assistance (MA) recipients residing in county nursing facilities. The transition payments were negotiated between the Department and the County Commissioner Association of Pennsylvania (CCAP). CCAP membership consists of all affected county nursing facilities who are aware of, and in agreement with, the transition payments provided by this rulemaking.
Need for Amendment
The Intergovernmental Transfer (IGT) agreement for FY 1997-1998 provides that a transition rate for county nursing facilities shall be extended to include the period January 1, 1999, to June 30, 1999. The IGT agreement for FY 1998-1999 provides that a transition rate for county nursing facilities shall be extended to include the period July 1, 1999, through June 30, 2003. Based on these IGT agreements, State Plan Amendments were submitted and approved. Transmittal number 99-007--Extension of County Transition Rates from January 1, 1999 through June 30, 1999 (approved by the Health Care Financing Administration (HCFA) on June 30, 1999) and Transmittal number 99-009--Extension of County Nursing Facility Transition Rates for the Period July 1, 1999 through June 30, 2003 (approved by HCFA on December 22, 1999).
Requirements
Section 1187.95 is being amended to include the extension of the transition payments for county nursing facilities from January 1, 1999, through June 30, 2003.
Affected Organizations
County nursing facilities participating in the MA program are eligible to receive transition payments.
Fiscal Impact
Public Sector The Commonwealth
The Department will see a continuation of the transition payments to county nursing facilities through 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 is effective January 1, 1999.
Sunset Date
There is no sunset date for this amendment.
Public Comments
Although this regulation 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 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).
In accordance with section 5.1(d) of the Regulatory Review Act, on September 24, 2001, this final-omitted regulation was deemed approved by the Committees. Under 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 public interest under sections 204(1)(iv) and (3) of the CDL and the regulation thereunder, 1 Pa. Code § 7.4(1)(iv) and (3).
(2) The adoption of this amendment 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 § 1187.95 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 January 1, 1999.
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: 14-468. (1) General Fund; (2) Implementing Year 2000-01 is $2,641,000; (3) 1st Succeeding Year 2001-02 is $1,584,000; 2nd Succeeding Year 2002-03 is $1,056,000; 3rd Succeeding Year 2003-04 is $0; 4th Succeeding Year 2004-05 is $0; 5th Succeeding Year 2005-06 is $0; (4) 1999-00 Program--$693,625,000; 1998-99 Program--$721,631,000; 1997-98 Program--$617,252,000; (7) MA--Long Term Care; (8) recommends adoption. Funds are included in the budget for this purpose.
Annex A TITLE 55. PUBLIC WELFARE PART III. MEDICAL ASSISTANCE MANUAL CHAPTER 1187. NURSING FACILITY SERVICES Subchapter F. COST REPORTING AND AUDIT REQUIREMENTS § 1187.95. General principles for rate and price setting.
(a) Prices will be set prospectively on an annual basis during the second quarter of each calendar year and be in effect for the subsequent July 1 through June 30 period.
(1) Peer group prices will be established for resident care costs, other resident related costs and administrative costs.
(2) If a peer group has an even number of nursing facilities, the median peer group price determined will be the arithmetic mean of the costs of the two nursing facilities holding the middle position in the peer group array.
(3) If a nursing facility changes bed size or MSA group, the nursing facility will be reassigned from the peer group used for price setting to peer group based on bed certification and MSA group as of April 1, for rate setting.
(4) The Department will announce, by notice submitted for recommended publication in the Pennsylvania Bulletin and suggested codification in the Pennsylvania Code as Appendix B, the peer group prices for each peer group.
(b) Rates will be set prospectively each quarter of the calendar year and will be in effect for 1 full quarter. Net operating rates will be based on peer group prices as limited by § 1187.107 (relating to limitations on resident care and other resident related cost centers). The nursing facility per diem rate will be computed as defined in § 1187.96(e) (relating to price and rate setting computations).
(1) Resident care peer group prices will be adjusted for the MA CMI of the nursing facility each quarter and be effective on the first day of the following calendar quarter.
(2) For the period of January 1, 1996, through June 30, 1996, each county owned and operated nursing facility, as defined in § 1187.2 (relating to definitions), receiving a county nursing facility rate as of June 30, 1995, will be provided a transition rate. The transition rate for each county nursing facility for January 1, 1996, through June 30, 1996, will be the higher of the facility case-mix rate for that quarter or a December 31, 1995, facility blended rate.
(i) The blended rate is calculated by multiplying the skilled/heavy care rate on file as of December 31, 1995, by the number of skilled/heavy care days as reported in the county nursing facility's most recently accepted cost report; multiplying the intermediate care rate on file as of December 31, 1995, by the number of intermediate care days reported in the county nursing facility's most recently accepted cost report; summing these products and dividing that sum by the number of skilled care, heavy care and intermediate care days as reported in the county nursing facility's most recently accepted cost report.
(ii) The rate established in subparagraph (i), will be trended forward 3 months from January 1, 1996, to March 31, 1996, by a factor equal to the HCFA Nursing Home Without Capital Market Basket Index as published in the second quarter 1995 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(3) For the period July 1, 1996, through June 30, 1997, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or a facility blended rate calculated in accordance with paragraph (2)(i) and (ii), trended forward 9 months from April 1, 1996, to December 31, 1996, by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 1995 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(4) For the period July 1, 1997, through June 30, 1998, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or the facility transition rate identified in paragraph (3), trended forward 12 months from January 1, 1997, to December 31, 1997, by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 1996 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(5) For the period July 1, 1998, through December 31, 1998, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or the facility transition rate identified in paragraph (4), trended forward 9 months from January 1, 1998, to September 30, 1998, by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 1997 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(6) For the period January 1, 1999, through June 30, 1999, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or the facility transition rate identified in paragraph (5), trended forward 6 months from January 1, 1999, to June 30, 1999, by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 1998 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(7) For the period July 1, 1999, through June 30, 2000, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or the facility transition rate identified in paragraph (6), trended forward 9 months by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 1998 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(8) For the period July 1, 2000, through June 30, 2001, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or the facility transition rate identified in paragraph (7), trended forward 12 months by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 1999 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(9) For the period July 1, 2001, through June 30, 2002, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or the facility transition rate identified in paragraph (8), trended forward 12 months by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 2000 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(10) For the period July 1, 2002, through June 30, 2003, transition rates for county nursing facilities will be the higher of the case-mix rate for each respective quarter or the facility transition rate identified in paragraph (9), trended forward 12 months by a factor equal to the HCFA Nursing Home without Capital Market Basket Index as published in the fourth quarter 2001 issue of the DRI McGraw-Hill publication ''Health Care Costs.''
(11) For the period January 1, 1996, through June 30, 1996, general nursing facilities other than hospital-based, special rehabilitation and county nursing facilities, will be provided a transition rate. The transition rate for each general nursing facility for each calendar quarter during the time period January 1, 1996, through June 30, 1996, will be the higher of the facility case-mix rate for that quarter or a July 1, 1994, facility blended rate. The facility blended rate is a composite of the skilled care and intermediate care interim per diem rates in effect on July 1, 1994, weighted by the reported MA days associated with the respective acuity levels.
[Pa.B. Doc. No. 01-1959. Filed for public inspection November 2, 2001, 9:00 a.m.]
