Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1187 - Nursing Facility Services
Subchapter H - PAYMENT CONDITIONS, LIMITATIONS AND ADJUSTMENTS
Section 1187.111 - Disproportionate share incentive payments

Universal Citation: 55 PA Code § 1187.111

§ 1187.111. Disproportionate share incentive payments

(a) A disproportionate share incentive payment will be made based on MA paid days of care times the per diem incentive to facilities meeting the following criteria for a 12-month facility cost reporting period:

(1) The nursing facility shall have an annual overall occupancy rate of at least 90% of the total available bed days.

(2) The nursing facility shall have an MA occupancy rate of at least 80%. The MA occupancy rate is calculated by dividing the MA days of care paid by the Department by the total actual days of care.

(b) The disproportionate share incentive payments will be based on the following for year 1 of implementation:

Overall
Occupancy
MA
Occupancy (y)
Per Diem
Incentive
Group A 90% [GREATER THAN EQUAL TO] 90% y $2.50
Group B 90% 88%[LESS THAN EQUAL TO] y <90% $1.70
Group C 90% 86%[LESS THAN EQUAL TO] y <88% $1.00
Group D 90% 84%[LESS THAN EQUAL TO] y <86% $0.60
Group E 90% 82%[LESS THAN EQUAL TO] y <84% $0.30
Group F 90% 80%[LESS THAN EQUAL TO] y <82% $0.20

(c) For each year subsequent to year 1 of implementation, disproportionate share incentive payments as described in subsection (b) will be inflated forward using the Health Care Financing Administration Nursing Home Without Capital Market Basket Index to the end point of the rate setting year for which the payments are made.

(d) These payments will be made annually within 120 days after the submission of an acceptable cost report provided that payment will not be made before 210 days of the close of the nursing facility fiscal year.

(e) For the period July 1, 2005, to June 30, 2009, the disproportionate share incentive payment to qualified nursing facilities shall be increased to equal two times the disproportionate share per diem incentive calculated in accordance with subsection (c).

(1) For the period commencing July 1, 2005, through June 30, 2006, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 2005, or June 30, 2006.

(2) For the period commencing July 1, 2006, through June 30, 2007, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 2006, or June 30, 2007.

(3) For the period commencing July 1, 2007, through June 30, 2008, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 2007, or June 30, 2008.

(4) For the period commencing July 1, 2008, through June 30, 2009, the increased incentive shall apply to cost reports filed for the fiscal period ending December 31, 2008, or June 30, 2009.

(The provisions of this § 1187.111 amended November 2, 2001, effective January 1, 1999, 31 Pa.B. 6046; amended June 23, 2006, effective July 1, 2006, 36 Pa.B. 3207.)
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