PRINTER'S NO. 1406
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
959
Session of
2019
INTRODUCED BY BARTOLOTTA, LAUGHLIN, COLLETT, KILLION,
LANGERHOLC, HUGHES, REGAN, SABATINA, MENSCH, ARGALL,
DINNIMAN, J. WARD, HUTCHINSON AND TOMLINSON,
NOVEMBER 20, 2019
REFERRED TO HEALTH AND HUMAN SERVICES, NOVEMBER 20, 2019
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
further providing for medical assistance payments for
institutional care.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 443.1(7) of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, is amended by
adding a subparagraph to read:
Section 443.1. Medical Assistance Payments for Institutional
Care.--The following medical assistance payments shall be made
on behalf of eligible persons whose institutional care is
prescribed by physicians:
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(7) After June 30, 2007, payments to county and nonpublic
nursing facilities enrolled in the medical assistance program as
providers of nursing facility services shall be determined in
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accordance with the methodologies for establishing payment rates
for county and nonpublic nursing facilities specified in the
department'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:
* * *
(vii) For each fiscal year beginning on or after fiscal year
2019-2020, an additional annual payment equal to one hundred
thirty dollars ($130) per eligible Medicaid ventilator or
tracheostomy day shall be paid to qualified medical assistance
nonpublic and county nursing facilities on a quarterly basis.
The department will obtain all necessary approvals and take all
steps required to ensure the distribution of these payments to
all qualifying nursing facilities under both the fee-for-service
program and the managed long-term services and supports program.
(A) A nonpublic or county nursing facility will qualify for
the payment if, during any quarter of the year, either of the
following criteria is met:
(I) For fiscal year 2019-2020 and thereafter, the facility
had:
(a) a minimum of ten medical assistance recipient residents
who received medically necessary ventilator care or tracheostomy
care according to the most recently available Picture Date CMI
Report; and
(b) at least seventeen percent of the facility's medical
assistance recipient resident population receiving medically
necessary ventilator care or tracheostomy care according to at
least one of the three most recently available medical
assistance Picture Date CMI Reports; or
(II) For fiscal year 2019-2020, the facility would have met
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the criteria in subclause I if the Picture Date CMI Report dated
November 1, 2019, had been among the most recently available
reports.
(B) The department shall calculate a qualified nonpublic or
county nursing facility's payment as follows:
(I) The determination of medically necessary ventilator care
is based on whether there is a positive response to MDS 3.0
Section O0100F1 or O0100F2 on the MDS assessment identified on
the Picture Date CMI Report. The determination of medically
necessary tracheostomy care is based on whether there is a
positive response to MDS 3.0 Section O0100E1 or O0100E2 on the
MDS assessment identified on the Picture Date CMI Report.
(II) For facilities that qualify for payment under clause
(A)(I), the quarterly payment shall equal the additional
supplemental ventilator care and tracheostomy care per diem
described in unit (a) multiplied by the number of eligible days
described in unit (b) as follows:
(a) The additional supplemental ventilator care and
tracheostomy care per diem shall equal ((the number of MA-
recipient residents who receive necessary ventilator care or
tracheostomy care/total MA-recipient residents) x $130) x (the
number of MA recipient residents who receive necessary
ventilator care or tracheostomy care/total MA-recipient
residents) as identified in the facility's most recently
available Picture Date CMI Report.
(b) If the facility meets the criteria of clause (A)(I)
during the payment quarter, the facility's eligible days for the
quarter are the facility's paid therapeutic and leave days; if
the facility does not meet the criteria of clause (A)(I) during
the payment quarter, the facility's eligible days for the
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quarter are zero.
(III) For facilities that qualify for payment under clause
(A)(II), the additional supplemental ventilator care and
tracheostomy care payment for fiscal year 2019-2020 shall be
calculated for each quarter as if the November 1, 2019, Picture
Date CMI Report were the facility's most recently available.
(C) The department shall continue to publish on a quarterly
basis the information contained in the Supplemental Ventilator
Care and Tracheostomy Care Payments file currently published on
the department's publicly accessible Internet website.
* * *
Section 2. This act shall take effect immediately.
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