Nursing Facility Assessment Program for Fiscal Year 2015-2016 [45 Pa.B. 6937]
[Saturday, December 5, 2015]This notice announces the amount of the assessment that the Department of Human Services (Department) is implementing for Fiscal Year (FY) 2015-2016, provides an explanation of the assessment methodology that the Department is using in FY 2015-2016 and identifies the estimated aggregate impact on nursing facilities which will be subject to the assessment.
Background
Article VIII-A of the Public Welfare Code (code) (62 P. S. §§ 801-A—815-A) authorizes the Department to impose an annual monetary assessment on nursing facilities and county nursing facilities in this Commonwealth each fiscal year through FY 2015-2016. Under Article VIII-A of the code, the Department may impose the assessment only to the extent that the assessment revenues qualify as the State share of Medical Assistance (MA) Program expenditures eligible for Federal financial participation (FFP). See 62 P. S. § 803-A. To ensure receipt of FFP, Article VIII-A of the code requires the Department to seek a waiver from the Federal Centers for Medicare and Medicaid Services if necessary to implement the Assessment Program. See 62 P. S. § 812-A.
For each fiscal year that the Assessment Program is implemented, the code authorizes the Secretary of the Department (Secretary) to determine the aggregate amount of the assessment and the annual assessment rate in consultation with the Secretary of the Budget. See 62 P. S. § 804-A. The act specifies that annual assessment rates must be sufficient to generate at least $50 million in additional revenue, but not more than the maximum aggregate assessment amount that qualifies for Federal matching funds. See 62 P. S. § 804-A.
The Secretary must publish a notice in the Pennsylvania Bulletin before imposing an annual assessment for a fiscal year. The notice must specify the amount of the assessment being proposed, explain the proposed assessment methodology, identify the estimated assessment amount and aggregate impact on nursing facilities subject to the assessment and provide interested persons a 30-day period to comment. See 62 P. S. § 805-A.
After consideration of any comments received during the 30-day comment period, the Secretary must publish a second notice announcing the rate of assessment for the fiscal year. See 62 P. S. § 805-A. The annual aggregate assessment amount and assessment rate for the fiscal year must be approved by the Governor. See 62 P. S. § 804-A.
The Secretary published a notice at 45 Pa.B. 2796 (June 6, 2015) announcing the proposed assessment rates, the aggregate amount and the impact for FY 2015-2016. No comments were received by the Department in response to the proposed rates notice.
Assessment Methodology and Rates for FY 2015-2016
The following nursing facilities will continue to be exempt from the Assessment Program in FY 2015-2016:
(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.
The Department will assess nonexempt nursing facilities at two rates. One rate will apply to four categories of nursing facilities: county nursing facilities; nursing facilities that have 44 or fewer licensed beds; qualified nursing facilities affiliated with Continuing Care Retirement Communities (CCRC) (see 40 Pa.B. 7297 (December 18, 2010)); and nursing facilities with an MA occupancy rate of at least 94% based on the 4 most recently submitted assessment quarter reports for each nursing facility as of November 5, 2014. The other rate will apply to all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010. Using the applicable rate, the Department will calculate each nonexempt facility's quarterly assessment amount by multiplying its assessment rate by the facility's non-Medicare resident days during the calendar quarter that immediately preceded the assessment quarter. This rate structure is essentially the same structure that was used in FY 2014-2015, but for an adjustment to the qualifications for the assessment rates.
Although the Department will maintain essentially the same basic rate structure for FY 2015-2016, the Department is increasing the assessment rate for nonexempt nursing facilities from the rates in FY 2014-2015. For FY 2015-2016, the assessment rates for nonexempt nursing facilities will be as follows:
(1) For county nursing facilities, for nursing facilities that have 44 or fewer licensed beds, for qualified CCRC nursing facilities and nursing facilities with an MA occupancy rate of at least 94% based on the latest 4 assessment quarters for each nursing facility as of November 5, 2014, the assessment rate will be $8.01 per non-Medicare resident day.
(2) For all other nonexempt nursing facilities, the assessment rate will be $30.06 per non-Medicare resident day.
Assessment payments are due the last day of the assessment quarter or 30 days after publication of this second notice, whichever is later.
The Assessment Program due dates, along with supplemental payment dates, will be available on the Department's web site at http://www.dhs.state.pa.us/provider/doingbusinesswithdhs/longtermcarecasemixinformation/index.htm.
Aggregate Assessment Amounts and Fiscal Impact
The Department estimates that the annual aggregate assessment fees for nonexempt nursing facilities will total $485.035 million. The Department will use the State revenue derived from the assessment fees and any associated Federal matching funds to support payments to qualified MA nursing facility providers in accordance with applicable laws and regulations.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, P. O. Box 8025, Harrisburg, PA 17105-8025. 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 (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-981. (1) General Fund; (2) Implementing Year 2015-16 is -$485,035,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$734,915,000; 2013-14 Program—$820,409,000; 2012-13 Program—$770,903,000; (7) Long-Term Care; (8) recommends adoption. This action will result in savings to the Commonwealth.
[Pa.B. Doc. No. 15-2147. Filed for public inspection December 4, 2015, 9:00 a.m.]
