1064 Payment for nursing facility services provided by county nursing facilities; medicaid day one incentive payments to county nursing facilities for Fiscal Year 2011-2012

Payment for Nursing Facility Services Provided by County Nursing Facilities; Medicaid Day One Incentive Payments to County Nursing Facilities for Fiscal Year 2011-2012

[41 Pa.B. 3305]
[Saturday, June 25, 2011]

 This announcement is to provide advance notice that the Department of Public Welfare (Department) intends to continue to make Medicaid Day One Incentive (MDOI) payments to qualified county nursing facilities through Fiscal Year (FY) 2011-2012.

Background

 The Department instituted the MDOI payments in FY 2006-2007 to encourage county nursing facilities to continue to serve as safety net providers by giving them a financial incentive to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission.

 For FYs 2006-2007 through 2010-2011, the Department provided MDOI payments to qualified county nursing facilities. The qualifying criteria and formula used to determine these payments, as set forth in the Commonwealth's approved State Plan, are as follows:

 To qualify for MDOI payments, the nursing facility must be a county nursing facility both during the entire quarter for which the MDOI installment payment is being made and at the time the MDOI installment payment is made.

 The Department will calculate each qualified county nursing facility's MDOI quarterly installment payment based on the following formula:

 (i) The total funds allocated for the MDOI payments for the rate year will be divided by the total MA days for all county nursing facilities to determine the MDOI per diem for the rate year. The total MA days used for each county nursing facility will be the MA days identified on the most recent PROMISe data file used to determine the facility's eligibility for disproportionate share incentive payments.

 (ii) The MDOI per diem for the rate year will be multiplied by each qualified county nursing facility's paid MA days identified on the most recent PROMISe data file used to determine eligibility for disproportionate share incentive payments, to determine its annual MDOI amount.

 (iii) Each qualified county nursing facility's annual MDOI amount will be divided by four to determine the facility's MDOI quarterly installment payments for the rate year.

 The MDOI installment payments for each quarter of the rate year will be paid in the first month of the following quarter.

 For FY 2011-2012, the Department intends to use a portion of the revenues generated from the FY 2011-2012 Nursing Facility Assessment Program (the act of June 30, 2007 (P. L. 49, No. 16) and public expenditures certified by the Department as the State share of the MDOI payments to qualified county nursing facilities. To authorize the continuance of the MDOI payments for FY 2011-2012, and the increase in the funding level for the MDOI payments for FY 2011-2012, the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS).

 If CMS approves the SPA the Department will have the authority to continue to make MDOI payments to county nursing facilities for FY 2011-2012 and increase the funding level for the MDOI for FY 2011-2012.

 The MDOI payments to county nursing facilities will provide incentives to county nursing facilities to provide services to individuals who are MA eligible on the day of admission. Nursing facilities are often reluctant to admit residents whose only source of coverage for nursing facility services is MA. County nursing facilities have traditionally acted as the safety net for those residents who have been denied admission to other nursing facilities. The MDOI payments are intended to assure that county nursing facilities continue to provide access to care for these individuals.

Fiscal Impact

 The estimated increase in annual aggregate expenditures during FY 2011-2012 is $20.575 million in State funds.

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 Marilyn Yocum, 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 Pennsylvania AT&T Relay Service at [phone] (TDD users) or [phone] (voice users).

GARY D. ALEXANDER, 
Acting Secretary

 Fiscal Note: 14-NOT-700. (1) General Fund; (2) Implementing Year 2010-11 is $0; (3) 1st Succeeding Year 2011-12 is $20,575,000; 2nd Succeeding Year 2012-13 is $0; 3rd Succeeding Year 2013-14 is $0; 4th Succeeding Year 2014-15 is $0; 5th Succeeding Year 2015-16 is $0; (4) 2008-09 Program—$672,597,000; 2009-10 Program—$540,266,000; 2010-11 Program—$713,831,000; (7) MA—Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 11-1064. Filed for public inspection June 24, 2011, 9:00 a.m.]