1177 Payments to nonpublic and county nursing facilities; proposed rates for State fiscal year 2013-2014

Payments to Nonpublic and County Nursing Facilities; Proposed Rates for State Fiscal Year 2013-2014

[43 Pa.B. 3587]
[Saturday, June 29, 2013]

 This notice announces the Department of Public Welfare's (Department) proposed annual case-mix per diem payment rates for State Fiscal Year (FY) 2013-2014 for nonpublic and county nursing facilities that participate in the Medical Assistance (MA) Program.

Non public Nursing Facility Per Diem Rates

 As required by the case-mix payment methodology set forth in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department intends to set an annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate will have four components: resident care; other resident related; administrative; and capital. For each quarter of FY 2013-2014, the Department will adjust the resident care component of each facility's rate by multiplying the resident care component by the facility's MA case-mix index for the appropriate picture date.

 In calculating the proposed rates, the Department assumed that peer group prices for FY 2013-2014 will be set as specified in 55 Pa. Code § 1187.94 (relating to peer grouping for price setting) except that for facilities classified as special rehabilitation facilities on or before July 1, 2000, peer group medians and prices will be determined in accordance with the methodology 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). Further, the phase-in of the Resource Utilization Group III version 5.12 44 Grouper classification system has been fully implemented in the rate setting process as specified in 55 Pa. Code § 1187.96 (relating to price- and rate-setting computations).

 In addition, in calculating the proposed rates, the Department assumed that the General Assembly will enact legislation authorizing the continued use of a budget adjustment factor (BAF) in setting MA payment rates for FY 2013-2014.¹ Upon reauthorization of the BAF, the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS) to include the BAF formula which the Department will use in FY 2013-2014.

 A detailed description of the BAF formulas for FY 2013-2014 is in the notice Payment for Nursing Facility Services Provided by County and Nonpublic Nursing Facilities; Notice of Change in Methods and Standards of Setting Payment Rates, published at 43 Pa.B. 3583 (June 29, 2013). Under the proposed formula, the BAF will 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 in effect for the fiscal year is limited to the amount permitted by the funds appropriated by the General Appropriations Act for the fiscal year.

 Finally, in calculating the proposed rates, the Department assumed that the General Appropriation Act of 2013 will include the level of funding in the Governor's Execu-tive Budget and that CMS will approve the SPA including the BAF formula for nonpublic nursing facilities.

County Nursing Facility Per Diem Rates

 As required by the rate methodology set forth in 55 Pa. Code Chapter 1189, Subchapter D (relating to rate setting), the Department intends to set an annual MA per diem rate for each county nursing facility provider. As specified 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 multiplied by a BAF determined in accordance with the formula in the Commonwealth's approved State Plan. The Department will submit a SPA to CMS to include the BAF formula which the Department will use in FY 2013-2014. In calculating the proposed rates, the Department assumed that the General Assembly will enact legislation authorizing the continued use of a BAF in setting MA payment rates for FY 2013-2014, that the General Appropriation Act of 2013 will include the level of funding in the Governor's Executive Budget and that CMS will approve the SPA including the BAF formula for county nursing facilities.²

 The proposed annual per diem rates for FY 2013-2014, the base BAF that will be applied to nonpublic nursing facility rates and the annual BAF that will be applied to county nursing facilities are available on the Department's web site at www.dpw.state.pa.us/provider/doing businesswithdpw/longtermcarecasemixinformation/index. htm and at local county assistance offices throughout this Commonwealth or by contacting Marilyn Yocum, Department of Public Welfare, Office of Long-Term Living at [phone].

Fiscal Impact

 If the proposed payment rates are adopted as final, the rates will result in an estimated increased cost of $54.768 million ($25.352 million in State funds) for per diem rate payments to nonpublic nursing facilities and an estimated increased cost of $12.057 million ($5.581 million in State funds) for per diem rate payments for county nursing facilities' FY 2013-2014 rates compared to the facilities' FY 2012-2013 per diem rates. The amount of funding available for this program is dependent upon the funds appropriated by the General Assembly in the forthcoming fiscal year. The Department assumed that funding for these changes will be included in the MA Long-Term Care appropriation.

Public Comment

 Interested persons are invited to submit written comments regarding the proposed annual rates for FY 2013-2014 to the Department of Public Welfare, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, P. O. Box 8025, Harrisburg, PA 17106-8025. 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 [phone] (TDD users) or [phone] (voice users).

BEVERLY D. MACKERETH, 
Acting Secretary

 Fiscal Note: 14-NOT-828. (1) General Fund; (2) Implementing Year 2013-14 is $30,933,000; (3) 1st Succeeding Year 2014-15 is $33,746,000; 2nd Succeeding Year 2015-16 is $33,746,000; 3rd Succeeding Year 2016-17 is $33,746,000; 4th Succeeding Year 2017-18 is $33,746,000; 5th Succeeding Year 2018-19 is $33,746,000; (4) 2012-13 Program—$765,923,000; 2011-12 Program—$737,356,000; 2010-11 Program—$728,907,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 13-1177. Filed for public inspection June 28, 2013, 9:00 a.m.]

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¹  The Department will finalize the BAF once the General Assembly has enacted a General Appropriations Act for FY 2013-2014 and will include the BAF in its notice announcing final MA nursing facility payment rates for the rate-setting year.

²  The Department will finalize the BAF once the General Assembly has enacted a General Appropriations Act for FY 2013-2014 and will include the BAF in its notice announcing final MA nursing facility payment rates for the rate-setting year.