Pennsylvania Code (Last Updated: April 5, 2016) |
Title 55. PUBLIC WELFARE |
PART III. Medical Assistance Manual |
Chapter 1187. Nursing Facility Services |
SubChapter H. PAYMENT CONDITIONS, LIMITATIONS ANDADJUSTMENTS |
Section 1187.107. Limitations on resident care and other resident related cost centers
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(a) The Department will set a limit on the resident care peer group price for each nursing facility for each year, using the NIS database as specified in § 1187.91 (relating to database), to the lower of:
(1) The nursing facility resident care peer group price.
(2) One hundred three percent of the nursing facilitys average case-mix neutralized resident care cost per diem plus 30% of the difference between the 103% calculation and the nursing facility resident care peer group price.
(b) The Department will set a limit on the other resident related peer group price for each nursing facility for each base year, using the NIS database as specified in § 1187.91 to the lower of:
(1) The nursing facility other resident related peer group price.
(2) One hundred three percent of the nursing facility average other resident related cost per diem plus 30% of the difference between the 103% calculation and the nursing facility other resident related peer group price.
Notation
This section cited in 55 Pa. Code § 1187.95 (relating to general principles for rate and price setting); and 55 Pa. Code § 1187.96 (relating to price- and rate-setting computations).