486 Payment for nursing facility services provided by nonpublic nursing facilities; Medical Assistance Day One incentive payments to nonpublic nursing facilities for fiscal year 2015-2016
DEPARTMENT OF
HUMAN SERVICESPayment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Medical Assistance Day One Incentive Payments to Nonpublic Nursing Facilities for Fiscal Year 2015-2016 [46 Pa.B. 1491]
[Saturday, March 19, 2016]This announcement provides advance notice that the Department of Human Services (Department) intends to continue to make Medical Assistance Day One Incentive (MDOI) payments to qualified nonpublic nursing facilities for Fiscal Year (FY) 2015-2016. The MDOI payments to nonpublic nursing facilities will provide incentives to nonpublic nursing facilities to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission. The MDOI payments are intended to encourage nonpublic nursing facilities to increase access to care for the poor and indigent citizens of this Commonwealth.
Background
The act of July 9, 2013 (P. L. 369, No. 55) and the act of July 10, 2014 (P. L. 1053, No. 126), among other things, directed the Department to make MDOI payments for FY 2013-2014 and FY 2014-2015 to qualified nonpublic nurs-ing facilities. The act of December 28, 2015 (P. L. 500, No. 92) also directs the Department to continue to make MDOI payments to qualified nonpublic nursing facilities for FY 2015-2016. The Department will use the Total Pennsylvania Medical Assistance (PA MA) days and Total Resident Days as reported by nonpublic nursing facilities under Article VIII-A of the Human Services Code (62 P. S. §§ 801-A—815-A), regarding nursing facility assessments, to determine eligibility and calculate payments.
To qualify for MDOI payments, the nursing facility must be a nonpublic nursing facility for the full Resident Day quarter prior to the applicable quarterly reporting due dates of October 31, January 31, April 30 and July 31. In addition, the nonpublic nursing facility shall have an overall occupancy rate of at least 85% and an MA occupancy rate of at least 65% during the Resident Day quarter. A nursing facility's overall occupancy rate for these payments will be determined as follows: Overall occupancy rate = (Total Resident Days ÷ (licensed bed capacity at the end of the quarter × the number of calendar days in the quarter)). A nursing facility's MA occupancy rate for these payments will be determined as follows: MA occupancy rate = Total PA MA days ÷ Total Resident Days.
Each nursing facility may qualify for a maximum of four MDOI payments. Using the nursing facility assessment quarterly resident day reporting forms available on October 31 for the first payment, January 31 for the second payment, April 30 for the third payment and July 31 for the fourth payment, the Department will calculate each qualified nonpublic nursing facility's MDOI payments based on the following formula:
(i) A MDOI per diem for each payment will be 1/4 of the total funds appropriated for the fiscal year divided by the Total PA MA days as reported by all qualifying nonpublic nursing facilities.
(ii) Each qualified nonpublic nursing facility's MDOI payment will be the per diem multiplied by a nonpublic nursing facility's Total PA MA days.
The Department will not retroactively revise an MDOI payment amount based on a nursing facility's late submission or revision of its report related to the previously listed dates. The Department may recoup payments based on an audit of a nursing facility's report.
The Department will submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS). If CMS approves the SPA, the Department will have the authority to make MDOI payments to nonpublic nursing facilities for FY 2015-2016.
Fiscal Impact
The fiscal impact of this change is estimated at $12.503 million ($6 million in State funds) for FY 2015-2016 and $4.167 million ($2 million in State funds) for FY 2016-2017.
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-996. (1) General Fund; (2) Implementing Year 2015-16 is $6,000,000; (3) 1st Succeeding Year 2016-17 is $2,000,000; 2nd Succeeding Year 2017-18 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$810,545,000; 2013-14 Program—$820,409,000; 2012-13 Program—$770,903,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 16-486. Filed for public inspection March 18, 2016, 9:00 a.m.]
