55 Pa. Code § 1187.91 - Database
The Department will set rates for the case-mix payment system based on the following data:
(1)
Net operating costs.
(i) The
net operating prices will be established based on the following:
(A) Audited nursing facility costs for the 3
most recent years available in the NIS database adjusted for inflation. This
database includes audited MA-11 cost reports that are issued by the Department
on or before March 31 of each July 1 price setting period.
(B) If a nursing facility that has
participated in the MA Program for 3 or more consecutive years has fewer than
three audited cost reports in the NIS database that are issued by the
Department on or before March 31 of each July 1 price setting period, the
Department will use reported costs, as adjusted to conform to Department
regulations, for those years not audited within 15 months of the date of
acceptance, until audits have been completed and are available in the NIS
database for price setting.
(C) If
a nursing facility, that has not participated in the MA Program for 3 or more
consecutive years, has fewer than three audited cost reports in the NIS
database that are issued by the Department on or before March 31 of each July 1
price setting period, the Department will use all available audited cost
reports in the NIS database.
(D)
For net operating prices effective on or after July 1, 2001, the Department
will revise the audited costs specified in clauses (A)-(C) by disregarding
audit adjustments disallowing or reclassifying to capital costs, the costs of
minor movable property (as defined in §
1187.2 (relating to definitions),
effective on July 1, 2001) or linens reported as net operating costs on cost
reports for fiscal periods beginning prior to January 1, 2001. The Department
will not adjust the audited statistics when revising the nursing facility
audited resident care, other resident care and administrative allowable costs
to disregard the adjustments relating to minor movable property and linen
costs. After revising the audited costs to disregard these adjustments, the
Department will recalculate the maximum allowable administrative cost, and will
disallow administrative costs in excess of the 12% limitation as specified in §
1187.56(1)(i)
(relating to selected administrative cost policies).
(ii) Subparagraph (i)(B) does not apply if a
nursing facility is under investigation by the Office of Attorney General. In
this situation, the Department will use a maximum of the three most recent
available audited cost reports in the NIS database used for price
setting.
(iii) A cost report for a
period of less than 12 months will not be included in the NIS database used for
each price setting year.
(iv) Prior
to price setting, cost report information will be indexed forward to the 6th
month of the 12-month period for which the prices are set. The index used is
the 1st Quarter issue of the CMS Nursing Home Without Capital Market Basket
Index.
(v) Total facility and MA
CMI averages from the quarterly CMI reports will be used to determine case-mix
adjustments for each price-setting and rate-setting period as specified in §
1187.96(a)(1)(i) and
(5) (relating to price- and rate-setting
computations).
(2)
Capital costs.
(i)
Fixed property component. The fixed property component of a
nursing facility's capital rate will be based upon the total assigned cost of
the nursing facility's allowable beds.
(ii)
Movable property
component. The movable property component of a nursing facility's
capital rate will be based upon the audited costs of the nursing facility's
major movable property as set forth in the nursing facility's most recent
audited MA-11 cost report available in the NIS database.
(iii)
Real estate tax cost
component. The real estate tax component of a nursing facility's
capital rate will be based upon the nursing facility's actual audited real
estate tax costs as set forth in the nursing facility's most recent audited
MA-11 cost report available in the NIS database.
Notes
The provisions of this § 1187.91 amended under sections 201(2), 206(2), 403(b) and 443.1(5) of the Public Welfare Code (62 P.S. §§ 201(2), 206(2), 403(b) and 443.1(5)).
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