1445 Payment for nursing facility services; nonpublic nursing facility medical assistance enhanced supplemental payments?

Payment for Nursing Facility Services; Nonpublic Nursing Facility Medical Assistance Enhanced Supplemental Payments

Purpose

[40 Pa.B. 4460]
[Saturday, August 7, 2010]

 The purpose of this announcement is to provide advance public notice that the Department of Public Welfare (Department) intends to change its methods and standards for payment of Medical Assistance (MA) nursing facility services to offer a new category of supplemental payment to qualified nonpublic MA nursing facilities.

Specific Requirements

 The Department is the Single State Agency responsible for the administration of the MA Program. The Department reimburses nonpublic MA nursing facilities for the services they render to MA recipients through a combination of per diem rate payments, which are computed under the case-mix payment methodology in 55 Pa. Code Chapter 1187 (relating to nursing facility services), and various supplemental payments, which are authorized in Chapter 1187 and the Commonwealth's approved Title XIX State Plan.

 Consistent with its focus on ensuring the sustainability of quality MA long-term living services to the consumers of those services, the Department intends to submit a State Plan Amendment (SPA) to the Federal Centers for Medicare and Medicaid Services (CMS) to authorize an Enhanced Supplemental (ES) Payment to nonpublic MA nursing facilities that meet specified criteria and agree to certain conditions. Under the proposed SPA, the Department would provide nonpublic nursing facilities that serve a disproportionate number of MA residents or serve MA residents with high care needs, or both, the opportunity to receive enhanced MA Program funding. Making this enhanced funding available is part of the Department's ongoing efforts to ensure that MA recipients continue to receive access to medically necessary nursing facility services and that those services result in quality care that improves the lives of those who receive them.

 In addition, consistent with the Department's focus on ensuring efficient use of tax dollars, the Department intends to include provisions in the proposed SPA to eliminate existing and potential litigation challenging the adequacy of the case-mix per diem rate payments. These measures will allow the Commonwealth and MA nursing facilities to direct more of their financial and staff resources into the delivery of services to consumers, rather than to underwriting the costs of protracted rate litigation. In addition, they will remove uncertainties and afford greater stability and predictability to the Commonwealth and to MA nursing facilities for budgeting and planning purposes.

 If CMS approves the SPA, the Department will make the ES Payments in two installments. Each installment will be comprised of several components. The amount of a qualifying nursing facility's ES Payment will depend on how many components the facility is eligible to receive. The Department will use its best efforts to process the first installment within 20 days of the date it receives notice from CMS that the SPA is approved. The Department will use its best efforts to process the second installment within 14 days after the first installment payment is made.

 The explanation of the qualifying criteria, the payment conditions, and the computation of the ES Payment is available in a Question and Answer document posted online at: http://www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/DoingBusiness/ LTCCaseMixInfo/.

 Payment of the ES Payments to qualified nursing facilities is contingent upon approval by CMS of the SPA and the facilities' signed agreement accepting the terms and conditions for receipt of the ES Payments.

Fiscal Impact

 The estimated increase in annual aggregate expenditures during Fiscal Year (FY) 2010-2011 is $22 million in State funds.

Public Comment

 Interested persons are invited to submit written comments regarding the ES Payments to Attn: Yvette Sanchez-Roberts, Department of Public Welfare/Department of Aging, Office of Long-Term Living, 555 Walnut Street, Forum Place, 5th Floor, 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 the Pennsylvania AT&T Relay Service at [phone] (TDD users) or [phone] (voice users).

HARRIET DICHTER, 
Secretary

 Fiscal Note: 14-NOT-653. (1) General Fund; (2) Implementing Year 2010-11 is $22,000,000; (3) 1st Succeeding Year 2011-12 is $0; 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) 2009-10 Program—$540,266,000; 2008-09 Program—$672,597,000; 2007-08 Program—$692,585,000; (7) Medical Assistance Long-Term Care; (8) recommends adoption. Funds have been included in the FY 2010-2011 enacted budget to cover this cost.

[Pa.B. Doc. No. 10-1445. Filed for public inspection August 6, 2010, 9:00 a.m.]