Current through Register Vol. 54, No. 12, March 23, 2024
The Department will establish rates for new nursing
facilities, nursing facilities with a change of ownership, reorganized nursing
facilities and former prospective payment nursing facilities as follows:
(1)
New nursing
facilities.
(i) The net operating
portion of the case-mix rate is determined as follows:
(A) A new nursing facility will be assigned
the Statewide average MA CMI until assessment data submitted by the nursing
facility under §
1187.33 (relating to resident data
and picture date reporting requirements) is used in a rate determination under
§
1187.96(a)(5)
(relating to price- and rate-setting computations). Beginning, July 1, 2010,
the Statewide average MA CMI assigned to a new nursing facility will be
calculated using the RUG-III version 5.12 44 group values in Appendix A and the
most recent classifiable assessments of any type. When a new nursing facility
has submitted assessment data under §
1187.33, the CMI values used to
determine the new nursing facility's total facility CMIs and MA CMI will be the
RUG-III version 5.12 44 group values and the resident assessment that will be
used for each resident will be the most recent classifiable assessment of any
type.
(B) The nursing facility will
be assigned to the appropriate peer group. The peer group price for resident
care, other resident related and administrative costs will be assigned to the
nursing facility until there is at least one audited nursing facility cost
report used in the rebasing process. Beginning July 1, 2010, a new nursing
facility will be assigned the peer group price for resident care that will be
calculated using the RUG-III version 5.12 44 group values in Appendix A and the
most recent classifiable assessments of any type.
(ii) The three components of the capital
portion of the case-mix rate are determined as follows:
(A)
Fixed property
component. The fixed property component will be determined in
accordance with §
1187.96(d)(1).
(B)
Movable property
component. The movable property component will be determined as
follows:
(I) The nursing facility's
acquisition cost, as determined in accordance with § 1187.61(b) (relating
to movable property cost policies), for any new items of movable property
acquired on or before the date of enrollment in the MA program, will be added
to the nursing facility's remaining book value for any used movable property as
of the date of enrollment in the MA program to arrive at the nursing facility's
movable property cost.
(II) The
nursing facility's movable property cost will then be amortized equally over
the first 3 rate years that the nursing facility is enrolled in the MA program
to determine the nursing facility's movable property component of the capital
rate.
(III) After the first 3 rate
years the nursing facility's movable property component will be based on the
most recent audited MA-11 cost report available in the NIS database. If no
MA-11 is available in the NIS database, the nursing facility will not receive
the movable property component of the capital rate.
(C)
Real estate tax
component.
(I) For the first 3 rate
years, the new nursing facility real estate tax component will be the nursing
facility's annual real estate tax cost as of the date of enrollment in the MA
program.
(II) After the first 3
rate years, the real estate tax component will be based on the audited MA-11
cost report available in the NIS database. If no audited MA-11 cost report is
available in the NIS database, the nursing facility will not receive the real
estate tax component of the capital rate.
(iii) Newly constructed nursing facilities
are exempt from the adjustment to 90% occupancy until the nursing facility has
participated in the MA Program for one full annual price setting period as
described in §
1187.95 (relating to general
principles for rate and price setting).
(iv) A new nursing facility is exempt from
the occupancy requirements in §
1187.104(1)(ii)
(relating to limitations on payment for reserved beds) until a CMI Report for
each of the three picture dates used to calculate overall occupancy as set
forth in §
1187.104(1)(iii)
is available for the rate quarter.
(2)
Nursing facilities with a change
of ownership and reorganized nursing facilities.
(i)
New provider. The new
nursing facility provider will be paid exactly as the old nursing facility
provider, except that, if a county nursing facility becomes a nursing facility
between July 1, 2006, and June 30, 2012, the per diem rate for the nursing
facility will be computed in accordance with §
1187.96, using the data contained
in the NIS database. Net operating and capital rates for the old nursing
facility provider will be assigned to the new nursing facility
provider.
(ii) If a county nursing
facility has a change of ownership from county ownership to a nonpublic nursing
facility provider, the nursing facility will be assigned to the appropriate
peer group in accordance with §
1187.94 (relating to peer grouping
for price setting) and the per diem rate for the nursing facility will be
calculated as follows:
(A) The net operating
portion of the case-mix rate is determined in accordance with §
1187.96 using the peer group price
for resident care, other resident related and administrative costs until a
nursing facility's cost report submitted by the new nursing facility provider
is audited for use in the rebasing process.
(B) The capital portion is determined using
only the fixed property component to the extent the facility is eligible for
the capital portion of the case mix rate, in accordance with §
1187.96(d)(1),
until a nursing facility's cost report submitted by the new nursing facility
provider is audited for use in the rebasing process.
(iii)
Transfer of data.
Resident assessment data will be transferred from the old nursing facility or
the county nursing facility provider number to the new nursing facility
provider number. The old nursing facility's or county nursing facility's MA CMI
will be transferred to the new nursing facility provider.
(iv)
Movable property cost
policies.
(A) The acquisition costs
of items acquired by the old nursing facility provider or county nursing
facility on or before the date of sale are costs of the old nursing facility
provider or county nursing facility, and not the new nursing facility
provider.
(B) Regardless of the
provisions of any contract of sale, the amount paid by the new nursing facility
provider to acquire or obtain any rights to items in the possession of the old
nursing facility provider or county nursing facility is not an allowable
cost.
(C) If the new nursing
facility provider purchases an item from the old nursing facility provider or
county nursing facility, the cost of that item is not an allowable cost for
cost reporting or rate setting purposes.
(D) If the new nursing facility provider
rents or leases an item from the old nursing facility provider or county
nursing facility, the cost of renting or leasing that item is not an allowable
cost for cost reporting or rate setting purposes.
(3)
Former prospective
payment nursing facilities. A nursing facility that received a
prospective rate prior to the implementation of the case-mix payment system
will be treated as a new nursing facility under paragraph (1) for the purpose
of establishing a per deim rate.
The provisions of this §
1187.97 amended under sections
201(2), 206(2), 403(b) and 443.1 of the Public Welfare Code (62 P. S.
§§
201(2),
206(2), 403(b) and
443.1).
This section cited in 55 Pa. Code §
1187.96 (relating to price- and
rate-setting computations).