H1421B3375A05438 MSP:CMD 07/08/22 #90 A05438
AMENDMENTS TO HOUSE BILL NO. 1421
Sponsor: SENATOR K. WARD
Printer's No. 3375
Amend Bill, page 2, line 29, by striking out "AND" and
inserting a comma
Amend Bill, page 2, line 30, by inserting after "PROGRAM"
and for human services
Amend Bill, page 2, line 54, by inserting after "ACCOUNTS;"
abrogating regulations;
Amend Bill, page 15, line 12, by striking out "PARAGRAPH (2)"
and inserting
subsection (b)
Amend Bill, page 69, by inserting between lines 14 and 15
ARTICLE XVI-T
HUMAN SERVICES
Section 1601-T. Eligibility for public assistance.
Notwithstanding any provision of law, beginning in State
fiscal year 2022-2023, the monthly State supplemental assistance
amounts for residents of a domiciliary care home, as defined in
section 2202-A of the act of April 9, 1929 (P.L.177, No.175),
known as The Administrative Code of 1929, or a personal care
home as defined in section 1001 of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, shall be as
follows:
Individual Couple
Domiciliary Care Home $634.30 $1,347.40
Personal Care Home $639.30 $1,357.40
Section 1602-T. Medical assistance payments for institutional
care.
Notwithstanding section 443.1(7)(iv) of the act of June 13,
1967 (P.L.31, No.21), known as the Human Services Code:
(1) Payments to county and nonpublic nursing facilities
enrolled in the medical assistance program as providers of
nursing facility services shall be determined in accordance
with the methodologies for establishing payment rates for
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county and nonpublic nursing facilities specified in the
Department of Human Services's regulations and the
Commonwealth's approved Title XIX State Plan for nursing
facility services in effect after June 30, 2007. The
following shall apply:
(i) Subject to Federal approval of such amendments
as may be necessary to the Commonwealth's approved Title
XIX State Plan, the Department of Human Services shall
apply a revenue adjustment neutrality factor to county
and nonpublic nursing facility payment rates so that the
estimated Statewide day-weighted average payment rate in
effect for that fiscal year is limited to the amount
permitted by the funds appropriated by the General
Appropriation Act for the fiscal year. The revenue
adjustment neutrality factor shall remain in effect until
the sooner of June 30, 2026, or the date on which a new
rate-setting methodology for medical assistance nursing
facility services which replaces the rate-setting
methodology codified in 55 Pa. Code Chs. 1187 (relating
to nursing facility services) and 1189 (relating to
county nursing facility services) takes effect.
(ii) Subject to Federal approval as may be
necessary, the following shall apply to nonpublic and
county nursing facility payment rates, to the extent
funds are appropriated for the purpose of rate increases
for increased direct resident care requirements and
resident care and related costs:
(A) Beginning January 1, 2023, the Department of
Human Services shall make capitation payments to
medical assistance Community HealthChoices managed
care organizations that include amounts exclusively
for the purpose of making payments to nonpublic
nursing facilities and county nursing facilities as
provided under clause (B)(I).
(B) The Department of Human Services shall adopt
a minimum payment rate for payments for services
rendered to medical assistance recipients under the
Community HealthChoices program, effective with dates
of service of January 1, 2023, through December 31,
2025, as follows:
(I) Community HealthChoices managed care
organizations shall apply no less than the
minimum payment rate to make payments to
nonpublic nursing facilities and county nursing
facilities for services rendered to medical
assistance recipients under the Community
HealthChoices program.
(II) The minimum payment rate shall be
greater than or equal to the following amounts:
(a) For nonpublic nursing facilities,
the nursing facility case-mix rates
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calculated in accordance with 55 Pa. Code Ch.
1187 (relating to nursing facility services)
and the Commonwealth's approved Title XIX
State Plan in effect for the dates of
service.
(b) For county nursing facilities, the
county nursing facility rates in accordance
with 55 Pa. Code Ch. 1189 (relating to county
nursing facility services) and the
Commonwealth's approved Title XIX State Plan
in effect for the dates of service.
(2) (Reserved.)
Section 1603-T. Resident care and related costs.
(a) County and nonpublic nursing facility.--The following
applies to a county and nonpublic nursing facility enrolled in
the medical assistance program:
(1) The county or nonpublic nursing facility shall
demonstrate on its submitted MA-11 that 70% of its total
costs, as reported by the facility, are resident care costs
or other resident-related costs under 55 Pa. Code §
1187.51(e)(1) and (2) (relating to scope).
(2) Except as provided under paragraph (3), the
Department of Human Services shall use the following
methodology to determine the facility's compliance with
paragraph (1):
(i) Add the facility's unallocated Total Net
Operating Costs reported as total expenses on the
facility's Schedule C of the MA-11, plus the following
capital costs reported by the facility on its Schedule C,
to determine the facility's total costs:
(A) Real estate taxes.
(B) Nursing facility assessment/HAI assessment.
(C) Depreciation.
(D) Interest on capital indebtedness.
(E) Rent on facility.
(F) Amortization capital costs.
(ii) Add the facility's unallocated Total Resident
Care Costs reported as total expenses on the facility's
Schedule C and the unallocated Total Other Resident
Related Costs reported as total expenses on the
facility's Schedule C to determine the facility's total
resident cost of care.
(iii) Divide the facility's total resident cost of
care under subparagraph (ii) by the facility's total
costs under subparagraph (i) to determine the percentage
of total costs related to resident care costs and other
resident-related costs.
(3) When a county or nonpublic nursing facility is
affiliated with a continuing care retirement community, the
following shall apply:
(i) The facility shall submit a supplemental cost
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report form apportioning the capital costs related to the
nursing facility, in a form and manner as prescribed by
the Department of Human Services .
(ii) The Department of Human Services shall use the
following methodology to determine the facility's
compliance with paragraph (1):
(A) Add the facility's unallocated Total Net
Operating Costs reported as total expenses on the
facility's Schedule C of the MA-11, plus the
following capital costs, reported by the facility on
its supplemental cost report form under subparagraph
(i), to determine the facility's total costs:
(I) Real estate taxes.
(II) Nursing facility assessment/HAI
assessment.
(III) Depreciation.
(IV) Interest on capital indebtedness.
(V) Rent on facility.
(VI) Amortization capital costs.
(B) Add the facility's unallocated
Total Resident Care Costs reported as total expenses
on the facility's Schedule C and the unallocated
Total Other Resident Related Costs reported as total
expenses on the facility's Schedule C to determine
the facility's total resident cost of care.
(C) Divide the facility's total resident cost of
care under clause (B) by the facility's total costs
under clause (A) to determine the percentage of total
costs related to resident care and other resident-
related costs.
(b) Penalty.--
(1) If in any 12-month cost-reporting period a county or
nonpublic nursing facility enrolled in the medical assistance
program fails to meet the resident care percentage under
subsection (a)(1), the Department of Human Services may
impose a penalty on the facility up to the difference between
the 70% of total costs requirement under paragraph (2) and
the percentage spent by the facility on resident care costs
or other resident-related costs, but no more than 5%.
(2) The formula for determining the maximum penalty
amount is as follows:
(i) Determine the percentage difference from the 70%
resident care requirement by subtracting the percentage
of total costs related to resident care and other
resident-related costs under subsection (a)(2)(iii) or
(3)(ii)(C) from 70%.
(ii) Determine the penalty amount as follows:
(A) Use the lesser of the following:
(I) Five.
(II) The difference under subparagraph (i).
(B) Multiply the lowest numeral under clause (A)
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by one hundredth (.01).
(C) Multiply the product under clause (B) by the
county or nonpublic nursing facility's fee-for-
service per diem payment rate as of June 30, 2022.
(D) Multiply the product under clause (C) by the
total MA resident days of care on the facility's MA-
11.
(3) A penalty imposed under this section shall be
transmitted by the facility to the Department of Human
Services for deposit into the Nursing Facility Quality
Improvement Fund.
(4) The Department of Human Services shall enforce the
penalty provisions under this subsection against full 12-
month cost reports with reporting periods that begin on or
after January 1, 2023, after making the first payment of the
increased county and nonpublic nursing facility rates, under
both the fee-for-service program and the Community
HealthChoices program, beginning January 1, 2023. If the
first payment of the increased county and nonpublic nursing
facility rates, including payments under both the fee-for-
service program and the Community HealthChoices program, is
after June 30, 2023, the enforcement of the penalty
provisions of this subsection shall commence with the first
full 12-month cost report after payment of the increased
county and nonpublic nursing facility rates.
(5) Paragraph (4) shall expire December 31, 2025.
(c) Nursing Facility Quality Improvement Fund.--
(1) The Nursing Facility Quality Improvement Fund is
established as a separate fund in the State Treasury and
shall be administered by the Department of Human Services .
(2) All interest earned from the investment or deposit
of money accumulated in the fund shall be deposited into the
fund for the same use.
(3) Money in the fund shall be expended by the
Department of Human Services for the following purposes:
(i) To administer and enforce this section.
(ii) To provide funding for nursing facility quality
improvement.
(d) Guidelines.--The Department of Human Services may
promulgate guidelines, as necessary, to implement this
section. The guidelines shall be transmitted to the Legislative
Reference Bureau for publication in the Pennsylvania Bulletin.
Prior to publication of the guidelines, the Department of Human
Services shall consult interested parties. The guidelines under
this section shall not be subject to:
(1) Sections 201, 202, 203, 204 and 205 of the act of
July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(2) Sections 204(b) and 301(10) of the act of October
15, 1980 (P.L.950, No.164), known as the Commonwealth
Attorneys Act.
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(3) The act of June 25, 1982 (P.L.633, No.181), known as
the Regulatory Review Act.
(e) Definitions.--As used in this section, the following
words and phrases shall have the meanings given to them in this
subsection unless the context clearly indicates otherwise:
"HAI." Hospital Acquired Infection.
"MA-11." The Medical Assistance Financial and Statistical
Report for Nursing Facilities and Services submitted to the
Department of Human Services by either a county nursing facility
or a nonpublic nursing facility for a 12-month cost report
period.
"Nonpublic nursing facility." A nursing facility other than
a county nursing facility or a facility owned or operated by the
Federal or State Government.
"Schedule C." The computation and allocation of allowable
costs schedule.
"Total MA resident days of care." The Nursing Facility MA
Fee-for-Service days of care and the Nursing Facility MA
Community HealthChoices days of care, as reported on the MA-11.
Section 1604-T. LIFE Program.
(a) Applicability.--This section shall apply notwithstanding
section 602 of the act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code.
(a.1) Information materials.--Informational materials and
Department of Human Services correspondence used by the
Department of Human Services and the Independent Enrollment
Broker to educate or notify an eligible individual about long-
term care services and supports, including an individual's
rights, responsibilities and choice of managed care organization
to cover long-term care services and supports, shall include the
following:
(1) A description of the LIFE program.
(2) A statement that an eligible individual has the
option to enroll in the LIFE program or a managed care
organization under the Community HealthChoices program.
(3) Contact information for LIFE providers.
(b) Training.--The Department of Human Services shall
continue to provide training to the Independent Enrollment
Broker on the LIFE program through the Independent Enrollment
Broker LIFE module to better educate the Independent Enrollment
Broker and to require that the LIFE program is offered equally
to eligible individuals.
(c) Report.--At the end of each quarter, the Department of
Human Services shall issue a report to the chairperson and
minority chairperson of the Health and Human Services Committee
of the Senate and the chairperson and minority chairperson of
the Human Services Committee of the House of Representatives
that tracks by county the enrollment of eligible individuals in
long-term care service programs by the Independent Enrollment
Broker, including managed care organizations and LIFE programs.
The report shall also include documentation of compliance with
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subsections (a) and (b).
Section 1605-T. Limits on reimbursements to counties.
M oney appropriated for community-based family centers may not
be considered as part of the base for calculation of a county's
child welfare needs-based budget for a fiscal year.
Section 1606-T. Nursing facility assessment time periods .
Notwithstanding section 815-A of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, the
assessment authorized in A rticle VIII-A of the Human Services
Code shall be imposed July 1, 2003, through June 30, 2026.
Amend Bill, page 120, line 26, by striking out "SECTION
443.13 OF THE HUMAN SERVICES CODE" and inserting
section 1603-T
Amend Bill, page 121, line 1, by striking out "443.1(7)(IV.1)
OF THE HUMAN SERVICES CODE" and inserting
1602-T(1)(ii)
Amend Bill, page 135, by inserting between lines 22 and 23
Section 37.1. Regulations are abrogated as follows:
(1) (Reserved).
(2) The following provisions of 55 Pa. Code, relating to
physician or certified registered nurse practitioner
notification requirements, are abrogated to the extent they
apply to individuals with symptoms of COVID-19:
(i) Section 3270.137 (relating to children with
symptoms of disease).
(ii) Section 3270.153 (relating to facility persons
with symptoms of disease).
(iii) Section 3280.137 (relating to children with
symptoms of disease).
(iv) Section 3280.153 (relating to facility persons
with symptoms of disease).
(v) Section 3290.137 (relating to children with
symptoms of disease).
(vi) Section 3290.153 (relating to facility persons
with symptoms of disease).
Amend Bill, page 136, by inserting between lines 20 and 21
Section 39.1. The addition of sections 1602-T(1)(i) and
1606-T of the act shall apply retroactively to June 29, 2022.
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