Payments to Nonpublic and County Nursing Facilities; Rates for State Fiscal Year 2011-2012 [42 Pa.B. 2111]
[Saturday, April 14, 2012]This notice announces the Department of Public Welfare's (Department) final annual case-mix per diem payment rates for State Fiscal Year (FY) 2011-2012 for most of the nonpublic and county nursing facilities that participate in the Medical Assistance (MA) Program. This notice also announces the proposed case-mix per diem payment rates for four of the special rehabilitation nursing facilities that participate in the MA Program for the period November 1, 2011, through June 30, 2012.
Nonpublic Nursing Facility Final Per Diem Rates
As required by the case-mix payment methodology regulations in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department annually sets an annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate is comprised of four components: resident care; other resident related; administrative; and capital.
Section 1187.96 of 55 Pa. Code (relating to price- and rate-setting computations) authorizes a 3-year phase-in of the use of the Minimum Data Set Resource Utilization Group III version 5.12 44 Grouper (RUG v 5.12) and the most recent classifiable resident assessments beginning July 1, 2010, and ending June 30, 2013. The phase-in provisions only affect the resident care component of a facility's case-mix per diem rate. The resident care rate used to establish a nursing facility's case-mix per diem rate is a blended resident care rate which consists of a portion of the resident care rate calculated using the previous RUG version 5.01 Grouper (RUG v 5.01) and the most recent comprehensive resident assessments and a portion of the resident care rate calculated using RUG v 5.12 and the most recent classifiable resident assessments. For FY 2011-2012, the nursing facility's blended resident care rate will equal 50% of the nursing facility's RUG v 5.01 resident care rate from the prior rate quarter adjusted by the percent increase or decrease in the RUG v 5.12 resident care rate and 50% of the nursing facility's RUG v 5.12 resident care rate.
The act of July 4, 2008 (P. L. 557, No. 44) (Act 44), among other things, directed the Department to phase-out the use of county nursing facility costs in nonpublic nursing facility rate setting over a period of 3 rate years, beginning with FY 2009-2010 and ending on June 30, 2012. Consistent with Act 44, the Department has continued to include county nursing facilities in deter- mining peer groups in accordance with 55 Pa. Code § 1187.94(1)(v) (relating to peer grouping for price setting) for the rate year 2011-2012. Once peer groups were determined, the Department calculated an interim median by adding each county nursing facility's costs from the three most recent audited cost reports or their reported costs if audited costs were not available to a noncollapsed peer group based on bed size and Metropolitan Statistical Area group. For rate year 2011-2012, the phase-out median equals 25% of the interim median plus 75% of the median calculated in accordance with 55 Pa. Code § 1187.98(b)(4) (relating to phase-out median determination).
In addition, the act of June 30, 2011 (P. L. 89, No. 22) (Act 22) amended the Public Welfare Code (62 P. S. §§ 101—1503) to authorize the Department to continue to apply a budget adjustment factor (BAF) in calculating rates for MA nonpublic and county nursing facilities for each fiscal year between July 1, 2011, and June 30, 2013. Federal Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 11-015 on November 21, 2011. SPA 11-015 states that the BAF shall limit payment rates for MA nursing facility services for county and nonpublic nursing facilities so that the Statewide day-weighted average payment rate for FY 2011-2012 is limited to the amount permitted by the funds appropriated by the General Appropriations Act of 2011. For FY 2011-2012, a BAF will be calculated each quarter for nonpublic nursing facilities. The formula the Department will use to determine a Quarterly BAF equals the annual target rate divided by the weighted average quarterly rate at 100%. If the Quarterly BAF as calculated is greater than 1.0, the Quarterly BAF will equal 1.0. The proposed change in rate methodology related to the special rehabilitation nursing facilities was not a factor in these quarterly BAF calculations.
County Nursing Facility Per Diem Rates
As required by the rate methodology in 55 Pa. Code Chapter 1189, Subchapter D (relating to rate setting), the Department annually sets an annual MA per diem rate for each county nursing facility provider. As stated in 55 Pa. Code § 1189.91(b) (relating to per diem rates for county nursing facilities), for each rate year beginning on or after July 1, 2007, the per diem rate paid to a county nursing facility for a rate year is the facility's prior rate year per diem rate multiplied by a BAF.
In addition, as required by 55 Pa. Code § 1189.91(d), the Department followed the formula in the Commonwealth's approved State Plan to determine that the BAF for FY 2011-2012 county nursing facilities is 1.0. CMS approved SPA 11-016 on November 21, 2011.
SPA 11-016 states that for rate setting years 2011-2012 and 2012-2013, the BAF shall limit the estimated Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the average payment rate for FY 2011-2012 is limited to the amount permitted by the funds appropriated by the General Appropriations Act of 2011.
The final per diem rates for FY 2011-2012 are available on the Department's web site at www.dpw.state.pa.us/provider/doingbusinesswithdpw/longtermcarecasemixinformation/index.htm, at local county assistance offices throughout this Commonwealth or by contacting Yvette Sanchez-Roberts, Department of Public Welfare, Office of Long-Term Living at (717) 265-7569.
Special Rehabilitation Proposed Per Diem Rates
For the period commencing November 1, 2011, peer group medians and prices will be established for the four nursing facilities that were classified as special rehabilitation nursing facilities on or before July 1, 2000 (Good Shepherd Home Raker Center, Inglis House, Margaret E. Moul Home and Good Shepherd Home—Bethlehem). These peer group medians and prices are separate from those for any other facilities meeting the definition of a special rehabilitation nursing facility as described in the notice Payment for Nursing Facility Services Provided by Special Rehabilitation Nursing Facilities; Change in Methods and Standards of Setting Payment Rates published at 41 Pa.B. 5826 (October 29, 2011). The Department intends to make additional changes to the payment methodology, for the period November 1, 2011, through June 30, 2012, so that this change in peer group methodology will not be a factor in the quarterly BAF calculations in the Commonwealth's approved State Plan. SPA 11-028 was submitted to the CMS on December 28, 2011.
Final annual per diem rates for Good Shepherd Home Raker Center, Inglis House, Margaret E. Moul Home and Good Shepherd Home—Bethlehem for the period November 1, 2011, through June 30, 2012, will be published as a public notice in the Pennsylvania Bulletin after CMS approval of SPA 11-028 and publication of regulations.
Public Process
The Department published a notice in the Pennsylvania Bulletin announcing its proposed case-mix per diem payment rates for nonpublic and county nursing facilities for FY 2011-2012 at 41 Pa.B. 3306 (June 25, 2011) and invited interested persons to submit comments. No comments were received by the Department in response to the proposed rate notice. In addition, the Department reviewed and considered the public comment received within the 30-day public comment period in response to the notice published at 41 Pa.B. 5826 related to the change in rate methodology for special rehabilitation nursing facilities.
Appeals
Following publication of this notice, the Department will send rate letters to notify MA nursing facilities of their final rates for FY 2011-2012. The rate letter will also advise the facility that it may file an administrative appeal if the facility believes that the Department made any errors or otherwise disagrees with its final rates for FY 2011-2012. A provider's appeal must be in writing and filed with the Department's Bureau of Hearings and Appeals, 2330 Vartan Way, 2nd Floor, Harrisburg, PA 17110-9721, within 33 days of the date of the Department's letter notifying the facility of its final rates. Facilities should refer to 67 Pa.C.S. Chapter 11 (relating to Medical Assistance hearings and appeals) and to the Department's regulations at 55 Pa. Code Chapter 41 (relating to Medical Assistance provider appeal procedures) for more detail regarding their appeal rights and the requirements related to written appeals.
Fiscal Impact
There is no fiscal impact for the change in final payment rates for FY 2011-2012 per diem rate payments to nonpublic and county nursing facilities compared to the facilities' final FY 2010-2011 per diem rates. The estimated fiscal impact for the proposed change in payment rates related to the four special rehabilitation nursing facilities for the period November 1, 2011, through June 30, 2012, is $0.331 million in State funds. Funding for these changes has been included in the MA Long-Term Care appropriation.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare/Department of Aging, Office of Long-Term Living, Bureau of Policy and Strategic Planning, Attention: Yvette Sanchez-Roberts, Forum Place, 5th Floor, 555 Walnut Street, Harrisburg, PA 17101-1919. 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).
GARY D. ALEXANDER,
SecretaryFiscal Note: 14-NOT-753. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 12-683. Filed for public inspection April 13, 2012, 9:00 a.m.]
