Payment for Nursing Facility Services Provided by County Nursing Facilities; Medical Assistance Day One Incentive Payments to County Nursing Facilities for Fiscal Year 2017-2018
[47 Pa.B. 3462]
[Saturday, June 17, 2017]
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) 2017-2018.
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 FYs 2006-2007 through 2016-2017, 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 a quarterly MDOI payment, the facility must be a county nursing facility both during the entire quarter for which the payment is being made and at the time the payment is made. A facility will not qualify for a quarterly payment if they are located in a geographic zone where Community Health Choices operates during the entire quarter for which the payment is being 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 quarter will be divided by the total MA days for all qualified county nursing facilities to determine the quarterly MDOI per diem. 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 (PROMISeTM) data file used to determine the facility's eligibility for disproportionate share incentive payments.
(ii) The quarterly MDOI per diem will be multiplied by each qualified county nursing facility's paid MA days identified on the most recent PROMISeTM data file used to determine eligibility for disproportionate share incentive payments, to determine its quarterly MDOI amount.
The MDOI payments for each quarter of the rate year will be paid in the first month of the following quarter.
For FY 2017-2018, the Department intends to use a portion of the revenues generated from the FY 2017-2018 Nursing Facility Assessment Program (see section 815-A of the Human Services 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 2017-2018, and the funding level for the MDOI payments for FY 2017-2018, the Department will submit a State Plan Amendment (SPA) to the Federal Centers for Medicare & 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 2017-2018.
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.
The estimated aggregate expenditures during FY 2017-2018 is $20.911 million ($10.075 million in State funds).
Interested persons are invited to submit written comments regarding these payments 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.
Persons with a disability who require an auxiliary aid or service may submit comments using Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
Fiscal Note: 14-NOT-1139. (1) General Fund; (2) Implementing Year 2016-17 is $0; (3) 1st Succeeding Year 2017-18 is $10,075,000; 2nd Succeeding Year 2018-19 through 5th Succeeding Year 2021-22 are $0; (4) 2015-16 Program—$968,083,000; 2014-15 Program—$810,545,000; 2013-14 Program—$820,409,000; (7) Long-Term Care; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 17-1019. Filed for public inspection June 16, 2017, 9:00 a.m.]
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