Pennsylvania Department of Public Welfare Office of Long Term Living Update PACAH FOG Meeting December 12, 2013 Anne Henry, Director, Bureau of Finance Randall Sipe, OLTL, Bur. of Policy and Regulatory Mgt.

AGENDA Legislation and Regulations Other OLTL Topics of Interest

Legislation and Regulations

Legislation Budget Adjustment Factor Reauthorized The use of a BAF in NF rate setting was legislatively reauthorized on July 9, 2013 to continue from July 1, 2013 through June 30, 2016

Regulations Rate Setting for County Homes with Changes of Ownership (CHOWs) Proposing Change to be eff. Nov 1, 2012 SPA was approved by CMS in late Feb 2013 Proposed Regs were published October 5, 2013 (1 public comment received, supportive of regs.) IRRC had no comments Approx. 5-6 months ‘til publication as final regulations. New Provider’s Rate Calculations: Until an Audited Cost Report from the New Provider is Available in NIS: Net Operating Components = Peer Group Prices Capital Component = Fixed Property Only ($26,0000/bed) MA CMI - Same as Previous Provider’s

Supplemental Vent Care Payments To be effective July 1, 2012 Eligibility: Eligibility determined Quarterly at each Picture Date (From MDS Data) CMI Reports contain info regarding eligibility each Picture Date Must have a minimum of 10 MA residents and at least 10% of your MA residents receiving vent care Supplemental Payments: Quarterly Lump Sum Payments Payment formula: (($69 X % MA Vent Residents) X % MA Vent Residents) X Paid MA Days for the Quarter Status: SPA approved by CMS on Dec13, 2012 Proposed Regs Published August 24, 2013 Estimated Pub. Date for Final Regs July-Aug 2014 Payments are being made now

Regulations Peer Group 13 Regulations Rate Setting and Peer Group Price Calculations for Special Rehab Facilities Effective November 1, 2011 Status: SPA approved by CMS in March, 2012 Final Regs estimated publication date May, 2014 NOTE: When PG 13 Regs are final we will publish Public Notices of : Final Rates and Final Peer Group Prices for FY’s 11-12, 12-13, and 13-14

Other Topics of Interest

Nursing Facility Rates FY Rates Will use best efforts to pay approximately 30 days after CMS approves BAF SPAs, based on “Proposed Rates” (Assuming Funds are Available) The BAF State Plan Amendments were approved Nov. 7 th Provider payments may be grouped as in previous years Payment schedule will be coordinated with Provider Assessment Schedule

New Procedure for NF Payment Notifications Beginning ASAP: Instead of Individualized Provider Letters… Post Payment Info to Case Mix Info Website Global s to Providers, Notifying of Web Postings and Appeal Rights Applicable to all payments except for rate letters

County MA Day One Incentive (MDOI) County MDOI for FY $53.3 million Total Funds Available (From CPE and NF Assessment Funds) Approx. Per Diem $19.36 (assuming 30 county homes) Status: Public Notice published June 29, 2013 SPA approved by CMS November 7, 2013 Payment amounts will be finalized and will be scheduled in the “Important Dates” schedule of the NF Assessment program

Pay for Performance (P4P) P4P for FY CPE Funded $6.5 million total funds available ($1.625 million distributed quarterly to qualifying county facilities) $ amount per facility depends on the number of qualifying facilities and the number of DSH days of each qualifying facility Status: SPA approved by CMS November 7, 2013 Payment scheduled for December 26,2013

County Supplementation Payment County NF Supplementation Payment For FY As directed by Act 71 of 2013: Facility must have an MA occupancy rate of at least 85%, and Located in a home rule county formally classified by the General Assembly as a second class A county Approx. $4.3 million total funds available, (if CMS approves the SPA) ($2 million in State Funds) Status: SPA approved by CMS November 7, 2013

Nonpublic MDOI Payment FY Nonpublic MDOI Payments $8M in State Funds Appropriated Will use Provider Assessment Days for Calculations and Qualifications Qualifications: Must be a nonpublic facility for full Provider Assessment Resident Day Quarter Must have an overall occupancy of 85% and MA occupancy of 65% during the Assessment Resident Day Quarter

Nonpublic MDOI Payment FY Nonpublic MDOI Payments Payments: Made Quarterly Quarterly Per Diem will be ¼ of the total funds appropriated, divided by the Total PA MA days reported by all qualifying nonpublic NFs Each facility’s payment will be the quarterly per diem multiplied by nursing facility's total PA MA Days Status SPA approved by CMS November 7, st payment scheduled December 26, 2013

Nursing Facility Assessments FY NF Assessment Proposed” Assessment Rates Notice published June 29, 2013 Assessment Fees: $8.32 for CCRC’s, County Homes and Providers with 50 beds or under; $29.77 for all other providers for non-MC Days Supplemental Payment - $16.91 per MA day Assessment-Funded Portion of County MDOI - $11.13 per MA day $177.9M of Assessment used for Rates – same as SFY 12/13 Status Final Assessment Notice expected to be published on Dec. 21, 2013 Working on “Important Dates” schedule

Nursing Facility Assessments Changes effective September 13, 2013 Specific Language to clarification that facilities must meet the Occupancy rule to classify Hospital Reserves as PA MA Hospital Reserve Days Reminder that Audit recoupments must be remitted within 15 days of notice. If not paid, final notice is issued. Fines and penalties may be assessed for non-payment Clarification that Audits may occur within 18 months of the original RA Date Provider Requests to Change Days still 1 year

Nursing Facility Assessments Other Changes Providers may now submit their resident days on a continuous basis without interruption (except for maintenance, repairs or necessary updates to the system) Once days are submitted, providers must call the Myers & Stauffer helpdesk in order to make changes. The help desk will RESET the form in order to allow for changes. Changes will be allowed until the close of the resident day submission period for each respective quarter.

Participation Review Participation Review Application Applications for Bed Requests and Bed Transfer Requests Drafted, reviewed by Associations and comments under review Website for public notices and where the workbook of statistical information y/office_of_long-term_living/19325

Preventable Serious Adverse Events DPW has held 3 meetings w/stakeholders between October 2013 and today, to develop a new Proposed PSAE bulletin. When agreement is reached, the proposed bulletin/Notice will be published for public comment. Then revisions based upon public input will be made, and A final bulletin/Notice will be published. Also a State Plan Amendment (SPA) must be presented to and approved by CMS

Conclusion QUESTIONS ?