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A00878
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
108
Session of
2021
INTRODUCED BY BARTOLOTTA, LAUGHLIN, LANGERHOLC, J. WARD, BLAKE,
MENSCH, AUMENT, BROOKS, COLLETT, HUTCHINSON, ARGALL,
TOMLINSON, REGAN, K. WARD AND HUGHES, JANUARY 22, 2021
REFERRED TO HEALTH AND HUMAN SERVICES, JANUARY 22, 2021
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:
* * *
(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
accordance with the methodologies for establishing payment rates
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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
2020-2021, 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.
The following shall apply:
(vii) For each fiscal year beginning on or after fiscal year
2021-2022, 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. The department shall
take all steps required to secure approval, if possible, for
Federal Medicaid matching funds. The following apply:
(A) A nonpublic or county nursing facility will qualify for
the payment if, during any quarter of the previous fiscal year,
the facility had:
(I) 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
(II) at least seventeen percent of the facility's medical
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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. the facility had a minimum
of one medical assistance recipient resident who received
medically necessary ventilator care or tracheostomy care
according to the most recent available Picture Date CMI Report.
(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) 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 as
identified in the facility's most recently available Picture
Date CMI Report.
(b) The facility's eligible days for the quarter payment
period are the facility's paid MA facility days and therapeutic
leave days; if the facility does not meet the criteria of clause
(A)(I) during the payment quarter period , the facility's
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eligible days for the quarter are zero.
(C) The department shall 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.
(D) The department shall ensure that payments calculated
under clause (B) are made to each eligible facility when
combining fee -for-services' and managed-care-entities' payments.
* * *
Section 2. This act shall take effect immediately.
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