Payments to Nursing Facilities--Proposed Rates for State Fiscal Year 2004-2005 [35 Pa.B. 1939] This notice announces the Department of Public Welfare's (Department) intent to make changes in the payment rates for Medical Assistance (MA) nursing facility providers for State Fiscal Year 2004-2005 (FY 04-05).
Under the Department's case-mix payment methodology, the Department establishes a new case-mix per diem payment rate for each MA nursing facility provider once for each fiscal year. Each provider's annual case-mix per diem rate is comprised of four cost components: (i) resident care; (ii) other resident related; (iii) administrative; and (iv) capital. For each quarter of the fiscal year, the Department adjusts the resident care cost component of each provider's rate by multiplying the resident care cost component by the provider's MA Case Mix Index for the appropriate picture date as follows: July 1 rate--February 1 picture date; October 1 rate--May 1 picture date; January 1 rate--August 1 picture date; and April 1 rate--November 1 picture date. See 55 Pa. Code § 1187.96 (relating to price and rate setting computations). The Department pays the provider for nursing facility services provided to MA recipients during that quarter using the provider's adjusted quarterly per diem rate.
The Department has calculated new annual case-mix per diem payment rates for FY 04-05 for MA nursing facility providers. The Department is proposing to adopt and make payments to MA nursing facility providers using these rates. For purposes of calculating these proposed rates, the Department assumed that the Metropolitan Statistical Area (MSA) regulations, which were published as proposed at 34 Pa.B. 4465 (August 14, 2004), will be adopted in final-form without further change and effective July 1, 2004.
The proposed FY 04-05 annual per diem rates are available on the Office of Medical Assistance Programs' (OMAP) website, www.dpw.state.pa.us/omap. The proposed FY 04-05 annual per diem rates are also available at local county assistance offices throughout this Commonwealth or by contacting Tom Jayson, Policy Unit, Bureau of Long Term Care Programs, (717) 705-3705.
The Department has also calculated adjusted quarterly rates for the July, October, January and April quarters of FY 04-05 for each MA nursing facility provider. These adjusted quarterly rates are also available on OMAP's website, at local county assistance offices and from Tom Jayson.
The database that the Department used to calculate the rates is available on OMAP's website. Since some of the audited cost reports in the database relate to fiscal periods beginning prior to January 1, 2001, the Department revised the audited costs in the database as specified in 55 Pa. Code § 1187.91(1)(iv)(D) (relating to database) to disregard certain audit adjustments disallowing minor movable property or linen costs. The criteria that the Department used to make these revisions are available on OMAP's website or by contacting Tom Jayson.
Fiscal Impact
The estimated increase in annual aggregate expenditures for MA nursing facility services for FY 04-05 is $176.975 million ($81.285 million in State funds).
Public Comment
Interested persons are invited to submit written comments regarding the proposed FY 04-05 rates to the Department within 30 days of this notice to Department of Public Welfare, Attention: Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Services at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
The Department will publish a notice announcing final rates for FY 04-05 once the MSA final rules are adopted. In setting final rates for FY 04-05, the Department will review and consider any comments received in response to this notice. In addition, the Department will make adjustments to the final rates as may be necessary depending on the outcome of the MSA rulemaking process when final rates for FY 04-05 are adopted.
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-415 (1) General Fund; (2) Implementing Year 2004-05 is $81,285,000; (3) lst Succeeding Year 2005-06 is $88,674,000; 2nd Succeeding Year 2006-07 is $88,674,000; 3rd Succeeding Year 2007-08 is $88,674,000; 4th Succeeding Year 2008-09 is $88,674,000; 5th Succeeding Year 2009-10 is $88,674,000; (4) 2003-04 Program--$588,528,000; 2002-03 Program--$777,084,000; 2001-02 Program--$761,877,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. Funds for Fiscal Year 2004-05 payments have been included in the 2004 General Appropriation Act. Funds for 2005-06 are reflected in the proposed budget for the Department.
[Pa.B. Doc. No. 05-569. Filed for public inspection March 25, 2005, 9:00 a.m.]
