DEPARTMENT OF
HUMAN SERVICESMedical Assistance Dependency Payment for High Volume Special Rehabilitation Facilities [46 Pa.B. 3701]
[Saturday, July 9, 2016]The Department of Human Services (Department) provides advance notice that the Department intends to make a supplemental payment in Fiscal Year (FY) 2016-2017 to certain special rehabilitation facilities (SRF) with high Medical Assistance (MA) and total facility occupancy levels.
Background
SRFs specialize in providing care and services to adults who have a neurological/neuromuscular diagnosis and severe functional limitations. See 55 Pa. Code § 1187.2 (relating to definitions). Because of the complex needs of their residents, SRFs generally incur staffing and specialized medical equipment costs that are much higher than the costs of other MA nursing facility providers. Further, SRFs with high MA and total facility occupancy levels are particularly dependent on MA payments to assure continued operations. This is particularly the case for SRFs that care for a large number of MA residents. To help offset the higher costs incurred by these high-volume, high-MA occupancy SRFs while those SRFs reconfigure to home and community-based services, the Department intends to make a supplemental payment to these facilities to assure that the unique services they provide continue to be available to MA beneficiaries.
Payment Qualifications
The determination of whether a nursing facility qualifies for a MA dependency payment and the nursing facility's payment amount is based on the nursing facility's 12-month MA cost report with a reporting period ending either December 31, 2014, or June 30, 2015, and accepted on or before April 1, 2016. To qualify for a MA dependency payment a nursing facility must meet the following requirements:
1) Be classified as an SRF as of the cost report end date.
2) Have MA occupancy greater than or equal to 94% as reported on Schedule A, Column A Line 5 of the cost report.
3) Have an overall nursing facility occupancy greater than or equal to 95% as reported on Schedule A, Column A Line 4 of the cost report.
4) Have at least 200 MA certified nursing facility beds as of the cost report end date.
Payments
For FY 2016-2017, the payment to qualifying facilities will be $40.55 times the number of MA days reported on their 12-month MA cost report with a reporting period ending either December 31, 2014, or June 30, 2015, and accepted on or before April 1, 2016.
Fiscal Impact
The fiscal impact of this change is estimated at $4.004 million ($1.931 million in State funds) for FY 2016-2017.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, P.O. Box 8025, Harrisburg, PA 17105-8025. 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 (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-1049. (1) General Fund; (2) Implementing Year 2015-16 is $0; (3) 1st Succeeding Year 2016-17 is $1,931,000; 2nd Succeeding Year 2017-18 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$810,545,000; 2013-14 Program—$820,409,000; 2012-13 Program—$770,903,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 16-1180. Filed for public inspection July 8, 2016, 9:00 a.m.]
