1437 Payment for nursing facility services provided by county nursing facilities; Medical Assistance Day One Incentive payments to county nursing facilities for fiscal year 2015-2016

Payment for Nursing Facility Services Provided by County Nursing Facilities; Medical Assistance Day One Incentive Payments to County Nursing Facilities for Fiscal Year 2015-2016

[45 Pa.B. 4317]
[Saturday, August 1, 2015]

 This announcement provides advance notice that the Department of Human Services (Department) intends to continue to make Medical Assistance Day One Incentive (MDOI) payments to qualified county nursing facilities through Fiscal Year (FY) 2015-2016.

Background

 The Department instituted the MDOI payments in FY 2006-2007 to encourage county nursing facilities to continue to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission.

 For FY 2006-2007 through FY 2014-2015, 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 Provider Reimbursement and Operations Management Information System (PROMISe^TM) 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 2015-2016, the Department intends to use a portion of the revenues generated from the FY 2015-2016 Nursing Facility Assessment Program (see section 815-A of the Public Welfare Code (62 P. S. § 815-A)) as the State share of the MDOI payments to qualified county nursing facilities. To authorize the continuance of the MDOI payments for FY 2015-2016, and the funding level for the MDOI payments for FY 2015-2016, 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 2015-2016.

 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. 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 provide for the poor and indigent citizens of this Commonwealth.

Fiscal Impact

 The estimated aggregate expenditures during FY 2015-2016 is $11.355 million in State funds.

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 [phone] (TDD users) or [phone] (voice users).

THEODORE DALLAS, 
Secretary

 Fiscal Note: 14-NOT-969. (1) General Fund; (2) Implementing Year 2015-16 is $11,355,000; (3) 1st Succeeding Year 2016-17 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.

 This notice has a cost and it is contained within the budget.

[Pa.B. Doc. No. 15-1437. Filed for public inspection July 31, 2015, 9:00 a.m.]