1697 Payment for nursing facility services provided by nonpublic nursing facilities; Medical Assistance Day One incentive payments to nonpublic nursing facilities for fiscal year 2013-2014

Payment for Nursing Facility Services Provided by Nonpublic Nursing Facilities; Medical Assistance Day One Incentive Payments to Nonpublic Nursing Facilities for Fiscal Year 2013-2014

[43 Pa.B. 5539]
[Saturday, September 14, 2013]

 This announcement provides advance notice that the Department of Public Welfare (Department) intends to make Medical Assistance Day One Incentive (MDOI) payments to qualified nonpublic nursing facilities for Fiscal Year (FY) 2013-2014. The MDOI payments to nonpublic nursing facilities will provide incentives to nonpublic nursing facilities to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission. The MDOI payments are intended to encourage nonpublic nursing facilities to increase access to care for the poor and indigent citizens of this Commonwealth.

Background

 Act 55 of 2013 (Act 55) was enacted in this Commonwealth on July 9, 2013. Act 55, among other things, directs the Department to make quarterly MDOI payments for FY 2013-2014 to qualified nonpublic nursing facilities. The Department will use the Total Pennsylvania Medical Assistance (PA MA) days and Total Resid- ent Days as reported by nonpublic nursing facilities under Article VIII-A of the Public Welfare Code (62 P. S. §§ 801-A—815-A), regarding nursing facility assessments to, determine eligibility and calculate payments.

 To qualify for MDOI payments, the nursing facility must be a nonpublic nursing facility for the full Resident Day quarter prior to the applicable quarterly reporting due dates of October 31, January 31, April 30 and July 31. In addition, the nonpublic nursing facility shall have an overall occupancy rate of at least 85% and an MA occupancy rate of at least 65% during the Resident Day quarter. A nursing facility's overall occupancy rate for these payments will be determined as follows: Overall occupancy rate = (Total Resident Days ÷ (licensed bed capacity at the end of the quarter × the number of calendar days in the quarter)). A nursing facility's MA occupancy rate for these payments will be determined as follows: MA occupancy rate = Total PA MA days ÷ Total Resident Days.

 Using the nursing facility assessment quarterly resident day reporting forms available on October 31, January 31, April 30 and July 31, the Department will calculate each qualified nonpublic nursing facility's MDOI quarterly payment based on the following formula:

 (i) The MDOI quarterly per diem will be 1/4 of the total funds appropriated for the rate year divided by the Total PA MA days as reported by all qualifying nonpublic nursing facilities.

 (ii) Each qualified nonpublic nursing facility's quarterly MDOI payment will be the quarterly per diem multiplied by a nonpublic nursing facility's Total PA MA days.

 The MDOI payments for each quarter of the rate year will be paid in the following quarter. The Department will not retroactively revise an MDOI payment amount based on a nursing facility's late submission or revision of its report related to the previously listed dates. The Department may recoup payments based on an audit of a nursing facility's report.

 The Department will submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS). If CMS approves the SPA, the Department will have the authority to make MDOI payments to nonpublic nursing facilities for FY 2013-2014.

Fiscal Impact

 The estimated increase in annual aggregate expenditures for FY 2013-2014 is $8 million in State funds.

Public Comment

 Interested persons are invited to submit written comments regarding this notice 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 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 Pennsylvania AT&T Relay Service at [phone] (TDD users) or [phone] (voice users).

BEVERLY D. MACKERETH, 
Secretary

 Fiscal Note: 14-NOT-843. (1) General Fund; (2) Implementing Year 2013-14 is $8,000,000; (3) 1st Succeeding Year 2014-15 is $0; 2nd Succeeding Year 2015-16 is $0; 3rd Succeeding Year 2016-17 is $0; 4th Succeeding Year 2017-18 is $0; 5th Succeeding Year 2018-19 is $0; (4) 2012-13 Program—$770,903,000; 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. 13-1697. Filed for public inspection September 13, 2013, 9:00 a.m.]