RSS FeedSTATUS OF MA RATE INCREASES FOR FY 09-10 STILL UNCERTAIN
As all members participating in the MA program are aware, you are still being reimbursed at your April 2009 rates for nursing facility care.
Information has been taken from the latest PANPHA member alert;
As all members participating in the MA program are aware, you are still being reimbursed at your April 2009 rates for nursing facility care. For some, this represents a significant decrease in cash flow below the rates you will be receiving once the FY 09-10 rates are published as final and paid. For others, the April 2009 MA rate exceeds the rates that you will receive when the FY 09-10 rates are published as final and paid, meaning the Department will recoup the reimbursement received in excess of your actual FY 09-10 rates. While PANPHA has learned that the Department will be publishing notices of proposed rates for both the FY 09-10 and FY10-11 rate years in the Pennsylvania Bulletin (www.pabulletin.com ) in June (June 19th or 26th bulletins are the most likely dates for those publications), we are unlikely to have a resolution to the situation in the near future.
Providers attending the recent education sessions held by the Office of Long-Term Living learned that the Department must receive approval of amendments of the Medicaid State Plan for the FY 09-10 ‘Budget Adjustment Factor’ and the County Homes ‘Phase-Out’ from the calculation of the non-public rates under Ch. 1187 before the FY 09-10 MA rates can be paid. That SPAs have been submitted to the Centers for Medicare and Medicaid Services (CMS). They in turn have reviewed them and provided the Department with a series of questions that the Department must answer and submit for review prior to approval. Those responses are in the process of being finalized within the Department, but have yet to be submitted to CMS. Once the Department submits their responses, CMS has 90 days to either approve or deny the SPA submission. Given the status of these SPAs, it is highly unlikely that the Department will receive approval to pay FY 09-10 rates to providers until late in the 1st Quarter of FY 10-11.
It appears that we are in for a long wait. We are still hopeful to have the final decision on the MA RUG-III level soon. The finalists are the 5.12 version with either the 34 or 44 Grouper. The chances are that it will be the 44 Grouper, but Bonnie Rose from the Office of Long Term Living states that it is not finalized as of yet. We will keep you posted.