Nursing Facility Rates

Managed Care Minimum Payment Rates — State Directed Payment

On December 30, 2022, the Centers for Medicare and Medicaid Services (CMS) approved a state-directed payment authorizing minimum payment rates to nursing faciliites in the Community HealthChoices managed care LTSS program. The minimum payment rates are effective with dates of services January 1, 2023 and later. The minimum payment rates consist of three parts:

• The approved State Plan rate per diem as determined in accordanance with State Plan attachment 4.19 D;
  
• A uniform rate per diem by provider class; and
  
• A facility specific rate per diem by provider class
  

For each nursing facility, the sum of the three amounts equals the minimum rate at which a CHC-MCO must contract with the facility

Minimum Payments Rates

• Minimum Payment Rates — Effective January 1, 2025
• Minimum Payment Rates — Effective October 1, 2024
• Minimum Payment Rates — Effective July 1, 2024
• Minimum Payment Rates — Effective April 1, 2024
• Minimum Payment Rates — Effective January 1, 2024
• Minimum Payment Rates — Effective October 1, 2023
• Minimum Payment Rates — Effective July 1, 2023
• Minimum Payment Rates Effective 4/1/2023 
• Minimum Payment Rates Effective 1/1/2023

Long Term Care/Case Mix Rates

On Jan. 1, 1996, the Department of Human Services (DHS) implemented 55 PA. Code Chapter 1187, the Nursing Facilities Services Case-Mix Reimbursement System. Case-mix rates for all Medical Assistance (MA) nursing facilities' were determined in accordance with the conditions and limitations specified in 55 PA. Code Chapter 1187 and the commonwealth's Title XIX State Plan. Beginning, Fiscal Year 2006-07, DHS changed the rate-setting methodology for MA county nursing facilities and reimbursed the facilities in accordance with 55 PA. Code Chapter 1189, for county nursing facilities, which was adopted June 23, 2006, and became effective July 1, 2006.

This section includes the most recent proposed case-mix rates as well as final rates beginning January 1996. Click on the appropriate link below to initiate steps to view the rate information you are interested in. This information is updated as notification of the proposed and final rates is published in the Pennsylvania Bulletin.

Rate Files

The rate files are Excel spreadsheets and Microsoft Excel is needed to access these files. Some of these pages are large and contain a great deal of information — please be aware that they may require several minutes to load.

• Proposed Rates — These are the most recent proposed case-mix rates.
  
• Condensed Final Rates — These are the condensed versions of final case-mix rates. These documents consist of Provider Names, MA CMI Averages, and Final Rates.
• Detailed Final Rates — These are full Excel spreadsheets for final case-mix rates. These spreadsheets consist of provider name, MA CMI averages, final rates, average per diems, peer group prices, limited prices, cost center rates, etc.
  

Crosswalk to Column Headings of Rate Spreadsheets

• 2021-2022 Detailed Final Rates
  
• 2020-2021 Detailed Final Rates
  
• 2019-2020 Detailed Final Rates