Current through Register Vol. 54, No. 44, November 2, 2024
(a) An inpatient psychiatric facility is not
entitled to additional reimbursement due solely to change of ownership or
control.
(b) If ownership changes,
the Department will establish per diem payment rates as follows:
(1) If the change involves only one inpatient
psychiatric facility, the Department will use the per diem payment rate
assigned to the inpatient psychiatric facility before the change.
(2) If the change combines two or more
inpatient psychiatric facilities into a single entity, such as a merger or
consolidation, the Department will establish a new per diem payment rate for
the new entity by averaging the rates of the previous entities on a
days-weighted basis. To determine that days-weighted average, the Department
will use the MA days of each previously enrolled inpatient psychiatric facility
as reported in the most recent fiscal year for which all the previous entities
filed acceptable Cost Reports (MA 336).
(3) If the change divides one enrolled
inpatient psychiatric facility into two or more entities, the Department will
use the per diem payment rate assigned to the inpatient psychiatric facility
before the change, for all resulting entities.
(4) The Department will not rebase rates
established under this subsection until it rebases rates Statewide.
(5) If the Department rebases rates Statewide
after a change in ownership has occurred, by using a base year which predates
or corresponds to the year of the change, the Department will use the Cost
Reports (MA 336) and the claims data for the base year regardless of who owned
the entity in that base year.
(c) If ownership changes, disproportionate
share payment policy is as follows:
(1) If the
change involves only one inpatient psychiatric facility, the Department will
use the disproportionate share status assigned to the inpatient psychiatric
facility before the change, so long as the inpatient psychiatric facility
maintains the nonemergency obstetric services by which it previously complied
with section 1923(d) of the Social Security Act (42 U.S.C.A. §
1396r-4(d)).
(2) If the change combines two or more
inpatient psychiatric facilities into a single entity, such as a merger or
consolidation, the Department will establish the new entity as eligible for
disproportionate share payments if one or more of the previous entities was
eligible for disproportionate share payments, so long as the resulting entity
maintains the nonemergency obstetric services by which one of the previous
entities complied with section 1923(d) of the Social Security Act. To determine
the monthly disproportionate share payment for the new entity, the Department
will add the monthly disproportionate share payments of the previous
entities.
(3) If the change divides
one enrolled inpatient psychiatric facility into two or more entities, the
Department will use the disproportionate share status assigned to the inpatient
psychiatric facility before the change, as long as each of the resulting
entities maintains the nonemergency obstetric services by which the previous
entity complied with section 1923(d) of the Social Security Act. The Department
will pro rate the monthly disproportionate share payment of the previous entity
on the basis of ratio of utilization agreed upon by the entities.
(4) The Department will not recalculate
disproportionate share status established under this subsection until it
recalculates disproportionate share status Statewide.
(5) If the Department makes a Statewide
redetermination of disproportionate share status after a change of ownership
has occurred, and uses a base year which predates or corresponds to the year of
the change, the Department will use the cost reports for the base year
regardless of who owned the entity in that base year.
(6) For a Statewide redetermination of
disproportionate share status, the determination of disproportionate share
status for the entities resulting from a division will be made on the basis of
ratio of utilization for the base year as agreed upon by the
entities.
(d) A hospital
that changes ownership or closes shall submit final Cost Reports (MA 336) to
the Department within 45 days of the change of ownership or closure.
(e) This section applies only to inpatient
psychiatric facilities which change ownership in the period July 1, 1993,
through June 30, 1995.
The provisions of this §1151.34 amended under sections 201
and 443.1(1) of the Public Welfare Code (62 P. S.
§§
201 and
443.1(1)).
This section cited in 55 Pa. Code §
1151.46 (relating to payment rate
calculations for Fiscal Year 1993-94 and
1994-95).