1Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2act to consolidate, editorially revise, and codify the public
3welfare laws of the Commonwealth," further providing for
4medical assistance payments for institutional care.

5The General Assembly of the Commonwealth of Pennsylvania
6hereby enacts as follows:

7Section 1. Section 443.1(7) of the act of June 13, 1967
8(P.L.31, No.21), known as the Public Welfare Code, amended June 
930, 2011 (P.L.89, No.22) is amended by adding a subparagraph to
10read:

11Section 443.1. Medical Assistance Payments for Institutional
12Care.--The following medical assistance payments shall be made
13on behalf of eligible persons whose institutional care is
14prescribed by physicians:

15* * *

16(7) After June 30, 2007, payments to county and nonpublic
17nursing facilities enrolled in the medical assistance program as
18providers of nursing facility services shall be determined in
19accordance with the methodologies for establishing payment rates

1for county and nonpublic nursing facilities specified in the
2department's regulations and the Commonwealth's approved Title
3XIX State Plan for nursing facility services in effect after
4June 30, 2007. The following shall apply:

5* * *

6(v) Subject to Federal approval of such amendments as may be
7necessary to the Commonwealth's approved Title XIX State Plan,
8for each fiscal year beginning on or after July 1, 2013, the
9department shall establish regulations for resident care
10spending requirements for nonpublic nursing facilities. The
11department shall recoup the funds if the requirements are not
12met. The following shall apply to the recoupment of funds:

13(A) The department shall recoup the funds if a nonpublic
14nursing facility does not spend at least ninety-five percent of
15the facility's medical assistance resident care component rate
16on allowable resident care costs as defined under the rate-
17setting methodology codified in 55 Pa. Code Ch. 1187. If a
18revenue adjustment neutrality factor to nonpublic nursing
19facility total medical assistance payment rates is in effect, as
20in subparagraph (iv), the resident care spending requirement
21shall be reduced so that the nonpublic nursing facility is
22required to spend at least ninety-five percent of the facility's
23medical assistance resident care component rate on allowable
24resident care costs as defined under the rate-setting
25methodology codified in 55 Pa. Code Ch. 1187.

26(B) To determine whether a nonpublic nursing facility meets 
27the requirement set forth in clause (A), the department shall 
28compare the facility's allowable resident care cost per diem as 
29reported in the facility's cost report and the medical 
30assistance resident care component per diem spending requirement
 

1for the corresponding period.

2(C) If the allowable resident care cost per diem the
3facility incurred is less than the medical assistance resident
4care component per diem spending requirement, the nonpublic
5nursing facility shall remit to the department the difference
6between the amounts multiplied by the number of medical
7assistance days paid during the corresponding period. Medical
8assistance managed care organization or Long-Term Care Capitated
9Assistance Program medical assistance days shall be excluded
10from the calculation.

11(D) Funds recouped by the department shall be directed back
12to the medical assistance program for nursing facility services
13and to cover any associated increased costs for administering
14this subparagraph.

15(E) A nonpublic nursing facility that changes ownership or
16control shall be liable for any outstanding recoupment amount,
17including outstanding amounts related to periods prior to the
18change of ownership or control.

19* * *

20Section 2. This act shall take effect in 60 days.