Payments to County Nursing Facilities; Final Rates for State Fiscal Year 2010-2011 [41 Pa.B. 2497]
[Saturday, May 14, 2011]This notice announces the Department of Public Welfare's (Department) final annual rates for State Fiscal Year (FY) 2010-2011 for county nursing facilities that participate in the Medical Assistance (MA) Program.
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 will be the facility's prior rate year per diem rate multiplied by a budget adjustment factor (BAF).
In addition, as required by 55 Pa. Code § 1189.91(d), the Department followed the formula set forth in the Commonwealth's approved State Plan to determine that the BAF for FY 2010-2011 for county nursing facilities is 1.0097. The Federal Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 09-017 on September 22, 2010.
SPA 09-017 states that for rate setting years 2009-2010 and 2010-2011, the BAF shall limit the estimated aggregate increase in the Statewide day-weighted average payment rate for MA nursing facility services for county and nonpublic nursing facilities so that the aggregate percentage rate of increase for the period that begins July 1, 2005, and ends on June 30, 2011, is limited to the amount permitted by the funds appropriated by the General Appropriations Acts. The formula for this BAF as it applies to county nursing facilities is BAF = 1.00 + 0.0097.
The final FY 2010-2011 annual per diem rates are available on the Department's web site at: www.dpw.state.pa.us/provider/doingbusinesswithdpw/longtermcarecasemixinformation/index.htm and 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) 705-3705.
Public Process
The Department published a notice in the Pennsylvania Bulletin announcing its proposed county per diem payment rates for FY 2010-2011 at 40 Pa.B. 3630 (June 26, 2010) and invited interested persons to submit comments. No comments were received by the Department in response to the proposed rate notice.
Appeals
Following publication of this notice, the Department will send rate letters to each county MA nursing facility to notify the facilities of their final rates for FY 2010-2011. 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 2010-2011. 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
The change in payment rates will result in an estimated increased cost of $5.385 million ($1.809 million in State funds) for per diem rate payments for county nursing facilities' FY 2010-2011 rates compared to the facilities' final FY 2009-2010 per diem rates.
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, Forum Place, 5th Floor, 555 Walnut Street, Attention: Yvette Sanchez-Roberts, 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,
Acting SecretaryFiscal Note: 14-NOT-687. (1) General Fund; (2) Implementing Year 2010-11 is $1,809,000; (3) 1st Succeeding Year 2011-12 is $1,809,000; 2nd Succeeding Year 2012-13 is $1,809,000; 3rd Succeeding Year 2013-14 is $1,809,000; 4th Succeeding Year 2014-15 is $1,809,000; 5th Succeeding Year 2015-16 is $1,809,000; The fiscal impact for 2011-12 and beyond assumes that the budget adjustment factor provided for in section 443.1 of the Public Welfare Code, which expires June 30, 2011, is not reauthorized beyond that date; (4) 2009-10 Program—$540,266,000; 2008-09 Program—$672,597,000; 2007-08 Program—$692,585,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 11-823. Filed for public inspection May 13, 2011, 9:00 a.m.]
