1161 Payment for nursing facility services; general nursing facility supplemental payment and county nursing facility Medical Assistance Day One Incentive Program

Payment for Nursing Facility Services; General Nursing Facility Supplemental Payment and County Nursing Facility Medical Assistance Day One Incentive Payment

[37 Pa.B. 3035]
[Saturday, June 30, 2007]

   The purpose of this announcement is to provide advance notice that the Department of Public Welfare (Department) intends to make changes in its methods and standards for payment of Medical Assistance (MA) nursing facility services beginning in Fiscal Year (FY) 2007-2008.

Background

   The Nursing Facility Assessment Law, the Act of September 30, 2003 (P. L. 169, No. 25) (Act 25) directed the Department to ''implement a monetary assessment'' on nonpublic licensed nursing facilities beginning July 1, 2003, and ending June 30, 2007, (hereafter referred to as the ''Assessment Program''). See sections 801-A and 815-A of Act 25. The Department intends to continue the Assessment Program for FYs 2007-2008 through 2011-2012 for general nursing facilities with the option of including county nursing facilities.

   The Commonwealth budget for MA long-term care services for FY 2007-2008 estimates that $430.025 million will be derived from State revenue collected from the Assessment Program and related Federal matching funds. Legislation must be enacted to continue the Assessment Program, to include the county nursing facilities, and to collect the anticipated State revenues. If legislation is enacted to continue the Assessment Program, a portion of the revenue generated from the assessment will enable the Department to continue to set payment rates for MA nursing facility services under the existing payment methodology contained in 55 Pa. Code Chapters 1187 and 1189 (relating to nursing facility services; and county nursing facility care).

   For general nursing facilities, in addition to reimbursing the MA allowable assessment cost, the Department intends to use a portion of the revenue to continue the supplemental payments as described in the Department's currently approved State Plan. To authorize the continuation of these payments beginning July 1, 2007, the Department will submit a State Plan Amendment to the Federal Centers for Medicare and Medicaid Services (CMS).

   For county nursing facilities, if the decision is made by the Department to include county nursing facilities in the Assessment Program, a portion of the revenue generated by the assessment will be used to increase the funding level for the county nursing facility MA Day One Incentive Payments (MDOI) provided for in the Department's currently approved State Plan. To authorize the increase in the funding level for the MDOI, the Department will submit a State Plan amendment to CMS.

   The Department projects that the assessment revenues and associated Federal matching funds will increase aggregate payments to MA nursing facility providers.

   If CMS approves the State Plan amendments, the Department will have the authority to make the supplemental payments to general MA nursing facilities and the increased MDOI payments to county nursing facilities.

   The supplemental payments to general MA nursing facilities will enable those facilities to increase salaries to direct care staff to maintain and increase staffing levels at a time when it is difficult to attract and retain qualified staff. The supplemental payments will also provide the facilities with additional funds to meet other unanticipated costs that may not be reflected in the current database used to establish rates, such as increased liability insurance costs.

   The increased MDOI payments to county nursing facilities will provide incentives to county nursing facilities to admit 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. These payments provide an incentive to county nursing facilities to continue to operate as safety net providers for the poor and indigent citizens of this Commonwealth.

Fiscal Impact

   As a result of this proposed policy change, the Department estimates that the annual aggregate assessment fees for nonexempt nursing facilities will total $430,025,000 for FY 2007-2008. All of the revenue derived from the assessment fees and associated Federal matching funds will be used to make payments to qualified MA nursing facility providers in accordance with applicable law and regulations.

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department at the following address Department of Public Welfare, Division of Long Term Care Client Services, Attention: Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. 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, service may submit comments using the AT&T Relay Service at [phone] (TDD users) or [phone] (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-514. No fiscal impact; (8) recommends adoption. This action is estimated to realize $430,025,000 in State revenue.

[Pa.B. Doc. No. 07-1161. Filed for public inspection June 29, 2007, 9:00 a.m.]