PRINTER'S NO. 2290
No. 1765 Session of 2003
INTRODUCED BY KENNEY, BROWNE, BUNT, CAPPELLI, CLYMER, CORRIGAN,
CRAHALLA, DAILEY, FAIRCHILD, FICHTER, FLICK, GEIST, GINGRICH,
GODSHALL, GOODMAN, HENNESSEY, HERMAN, HESS, LEWIS, MAITLAND,
McNAUGHTON, NAILOR, O'NEILL, REICHLEY, ROSS, RUBLEY, SATHER,
SCHRODER, STERN, T. STEVENSON, E. Z. TAYLOR, TIGUE, TRUE,
VANCE, WASHINGTON, WATSON, WEBER AND YOUNGBLOOD,
JUNE 30, 2003
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
JUNE 30, 2003
AN ACT
1 Requiring the Legislative Budget and Finance Committee to
2 conduct an immediate actuarial study of the adequacy of
3 Pennsylvania's medical assistance nursing facility
4 reimbursement rates; and prohibiting any reduction in nursing
5 facility payment rates until the study is completed.
6 The General Assembly finds and declares as follows:
7 (1) Medical assistance pays for almost 65% of the
8 nursing facility care in Pennsylvania.
9 (2) In most cases, the reimbursement provided by the
10 Department of Public Welfare to medical assistance-certified
11 nursing facilities is lower than the cost of the care
12 provided to residents.
13 (3) The combination of medical assistance rates that do
14 not meet the cost of nursing home care and additional
15 decreases in Federal Medicare reimbursement threaten access
16 to long-term care services for the almost 2,000,000
1 Pennsylvanians 65 years of age or older.
2 (4) It is in the best interest of the citizens of this
3 Commonwealth that a comprehensive study of the adequacy of
4 nursing facility payment rates is conducted.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 Section 1. Short title.
8 This act shall be known and may be cited as the Adequate
9 Nursing Facility Payment Act.
10 Section 2. Definitions.
11 The following words and phrases when used in this act shall
12 have the meanings given to them in this section unless the
13 context clearly indicates otherwise:
14 "Committee." The Legislative Budget and Finance Committee.
15 "Department." The Department of Public Welfare of the
16 Commonwealth.
17 "MA-11-Financial and Statistical Report Schedules." As
18 defined by 55 Pa. Code Ch. 1187 (relating to nursing facility
19 services).
20 "Medical assistance payment rates." The medical assistance
21 payment rates made by the Department of Public Welfare to
22 nursing facilities as calculated in 55 Pa. Code Ch. 1187
23 (relating to nursing facility services).
24 "Nursing facility." A general nursing facility, hospital-
25 based or county nursing facility licensed by the Department of
26 Health and enrolled in the medical assistance program.
27 Section 3. Study and report.
28 (a) Study.--The General Assembly hereby declares that the
29 committee shall conduct a study of the department's nursing
30 facility payment rates by obtaining the following:
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1 (1) The nursing facilities' costs as reported in the MA-
2 11 Financial and Statistical Report form for the most recent
3 period available and broken down into the following major
4 categories:
5 (i) Resident care costs.
6 (ii) Other resident-related care costs.
7 (iii) Administrative costs.
8 (iv) Capital costs.
9 (2) The medical assistance payment rates for the same
10 period, broken down into the major categories listed under
11 subsection (a)(1).
12 The study should then be compared to the nursing facilities'
13 costs as determined under subsection (a)(1) with the medical
14 assistance payment rates under subsection (a)(2) to determine
15 their adequacy.
16 (b) Report.--Based on the findings of the study, the
17 committee shall provide a report to the General Assembly which
18 discusses the rate information obtained, the comparison of
19 nursing facility costs to medical assistance reimbursement rates
20 and other findings from the study and makes recommendations
21 regarding the adequacy of the rates. The report shall be
22 transmitted to the chairman and minority chairman of the
23 Appropriations Committee of the Senate, the chairman and
24 minority chairman of the Public Health and Welfare Committee of
25 the Senate, the chairman and minority chairman of the Aging and
26 Youth Committee of the Senate, and to the chairman and minority
27 chairman of the Appropriations Committee of the House of
28 Representatives, the chairman and minority chairman of the
29 Health and Human Services Committee of the House of
30 Representatives and the chairman and minority chairman of the
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1 Aging and Older Adult Services Committee of the House of
2 Representatives. The report shall be presented no later than
3 March 1, 2004.
4 Section 4. Limitations on rate reduction.
5 The department may not promulgate statutory or regulatory
6 changes to decrease the nursing facility payment rates until the
7 report required under this act has been presented to the General
8 Assembly and a minimum of three public hearings have been held
9 on the findings in the report.
10 Section 5. Effective date.
11 This act shall take effect July 1, 2003, or immediately.
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