55 Pa. Code § 1187.108 - Gross adjustments to nursing facility payments

(a) The case-mix payment system is a prospective system. There is no cost settlement under the case-mix payment system.

(b) Certain adjustments may be made which increase or decrease the payment which a nursing facility may have otherwise received. Gross adjustments to nursing facility payments are based on one or more of the following general provisions:

(1) If audit findings result in changing the peer group median and the peer group price, a retrospective gross adjustment is made for each nursing facility in the peer group where the change occurred.

(2) If a nursing facility's MA CMI changes as a result of UMR resident assessment audit adjustments, retrospective gross adjustments shall be made for the nursing facility involved.

(c) Specific adjustments of the gross payments received by a nursing facility may be required by §§ 1187.109-1187.115.

Notes

55 Pa. Code § 1187.108

This section cited in 55 Pa. Code § 1187.141 (relating to nursing facility's right to appeal and to a hearing).