Current through Register Vol. 54, No. 44, November 2, 2024
(a) The Department will establish maximum
group per diem rate ceilings for allowable net operating costs for each level
of care for general and county operated nursing facilities. Effective April 1,
1988, these ceilings will be based on 115% of the median of year-end reported
costs excluding depreciation and interest. Facilities will not be reimbursed
for net operating costs above the maximum group per diem rate ceilings. Costs
which are not reimbursed within the established ceilings for a fiscal year may
not be carried forward or backward to other fiscal years. The ceilings for
general and county operated nursing facilities will be established as follows:
(1) The Department will use only year-end
cost reports that cover a period of at least 180 days, are acceptable and
received at least 90 days prior to the implementation date of the new ceilings.
An acceptable cost report is one in which the following requirements are met:
(i) Applicable items are fully completed in
accordance with the instructions incorporated in the Department's cost report,
including the necessary original signatures on the required number of
copies.
(ii) Computations carried
out on the form are accurate and consistent with other related
computations.
(iii) The treatment
of costs conforms to the applicable requirements of this subchapter and
Subchapters B and C (relating to manual for allowable cost reimbursement for
skilled nursing and intermediate care facilities; and Reserved).
(iv) Required documentation is
included.
(2) In
establishing net operating ceilings, the data from the provider's latest
acceptable cost report will be brought forward to a common date by using
multipliers developed by the Department based on the most current revised urban
wage earners and clerical workers consumer price index (CPI-W, 1967 = 100, all
items, all cities, United States average). This factor will adjust for
inflation for the period from the end-date of each cost report to the common
date.
(3) To account for the period
from the common date to the end date for which these ceilings will be in
effect, the Department will again utilize a combination of inflation factors.
If actual inflation factors are available, CPI-W will be utilized. If actual
CPI-W is not available, the Department will take into account projected
economic indicators, such as CPI-W. During Fiscal Years 1992-1993, 1993-1994
and 1994-1995, the Department will utilize CPI-W plus an amount equal to the
difference between CPI-W and the DRI McGraw-Hill Health Care Costs-Nursing Home
Market Basket applied to the full year ceiling setting period applicable to the
last day of the second quarter of the calendar year, as the inflation factor
under this paragraph. The Department will also increase the ceilings so
calculated by an additional factor equal to 2.5%.
(4) The inflation factors used, the common
date and the number of cost reports by facility year utilized will be published
in the notice in the Pennsylvania Bulletin which establishes
each new ceiling.
(5) Metropolitan
Statistical Area (MSA) group ceilings for allowable net operating costs for
county nursing facilities and general nursing facilities, excluding
hospital-based and special rehabilitation facilities, will be established at
least annually by the Department. Effective April 1, 1988, these ceilings will
be based on 115% of the median of year-end reported costs excluding
depreciation and interest. The groups used by the Department will be based on
the classification levels announced by the Federal Office of Management and
Budget no later than 90 days before the implementation date of the new
ceilings. The Department will establish a separate ceiling for general nursing
facilities, excluding hospital-based and special rehabilitation facilities, in
counties which are located in Level A statistical areas, for those in Level B
statistical areas, for those in Level C statistical areas and for those in
nonstatistical areas under the Federal system. The Department will establish a
separate ceiling for county nursing facilities in counties located in either
Level A or Level B statistical areas and one for county nursing facilities in
counties located in either Level C statistical areas or in nonstatistical areas
under the Federal system.
(6) The
Department will announce, by notice submitted for recommended publication in
the Pennsylvania Bulletin and suggested codification in the
Pennsylvania Code as an appendix to this section, the
classification levels and the applicable per diem ceilings for the location of
the facility, level of care, type of facility and date of service involved. A
fiscal note, as required by section 612 of The Administrative Code of 1929
(71
P. S. §
232), will accompany the
notice.
(b) Statewide
ceilings for allowable net operating costs will be established at least
annually by the Department under the method in subsection (a)(1)-(4) and (6)
for hospital-based nursing facilities. Effective April 1, 1988, these ceilings
will be based on 115% of the median of year-end reported costs excluding
depreciation and interest.
(c)
Statewide ceilings for allowable net operating costs will be established at
least annually by the Department under the method in subsection (a)(1)-(4) and
(6) for special rehabilitation facilities. Effective April 1, 1988, these
ceilings will be based on 115% of the median of year-end reported costs
excluding depreciation and interest.
(d) State-operated intermediate care
facilities for the mentally retarded are reimbursed actual allowable costs
under Medicare principles, subject to MA regulations. NonState-operated
intermediate care facilities for the mentally retarded are reimbursed actual,
allowable, reasonable costs under Subchapter C and other applicable MA
Regulations.
(e) Psychiatric
transitional facilities are reimbursed actual allowable costs under Medicare
principles and within the limits of their budgets.
See 22 Pa.B. 3749 (July 18, 1992) for nursing home
pooling provisions.
The provisions of this §1181.66 amended under sections
201, 403 and 443.1(2) and (3) of the Public Welfare Code (62 P. S. §§
201,
403 and
443.1 (2) and
(3)).
This section cited in 55 Pa. Code §
1181.45 (relating to ongoing
responsibilities of providers); 55 Pa. Code §
1181.51 (relating to general
payment policy); 55 Pa. Code §
1181.52 (relating to payment
conditions); 55 Pa. Code §
1181.73 (relating to final
reporting); 55 Pa. Code §
1181.74 (relating to auditing
requirements related to cost reports); and 55 Pa. Code §
1181.217 (relating to establishing
ceilings for allowable net operating
costs).
