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    Long-Term Care for Providers

    Nursing Facility Assessment

    The Centers for Medicare and Medicaid Services (CMS) approved the Commonwealth of Pennsylvania's request to implement a Pennsylvania Nursing Facility Assessment Program, which was authorized by the General Assembly in September 2003. The General Assembly authorized the Department of Human Services (DHS) to collect this assessment from all nongovernmental licensed nursing facilities. The revenue from this assessment will be used to maintain Medical Assistance (MA) rates and provide additional reimbursement to MA-participating nursing facilities.

    As part of the assessment program, each non-exempt nursing facility must submit a report of specific resident days for each reporting quarter.

    The reported days will include the following: Pennsylvania MA facility and therapeutic leave days, Pennsylvania MA hospital reserve days, Pennsylvania MA managed care days, Pennsylvania MA hospice days, Long-Term Care Capitated Assistance Program (LTCCAP) days, Pennsylvania MA pending days, other states' MA days, private paydays, and Medicare days.

    Nursing facilities should be prepared to provide information regarding the licensed bed size at the end of each quarter and whether the facility participated as a Continuing Care Retirement Community on the last day of the reporting quarter. Nursing facilities submit this information for each quarter using the Pennsylvania Nursing Facility Submission System.

    Questions about the assessment program should be submitted to the Bureau of Finance Division of Rate Setting and Auditing's Nursing Home Assessment Unit by calling 717-787-1171.

    • CMCS Informational Bulletin — February 2023 Health Care-Related Taxes and Hold Harmless Arrangements Involving the Redistribution of Medicaid Payments

    Nursing Facility Assessment Program
    Important Dates for 2024-2025

    ActionTransactionAssessment QuartersDate
    RDR Submission*Due Date for Submission of Resident Day Report for NF Assessment Note: Assessment Quarter 1 - Resident Days April 1, 2024 -June 30, 2024Assessment Quarter 2 - Resident Days July 1, 2024 - September 30, 20241 & 2 (Q85 & Q86)2/7/2025
    Assessments**Due Date for NFs to Send ACH or Wire Transfers for Assessment Fees1 & 2 (Q85 & Q86)3/3/2025
    RDR Submission*Due Date for Submission of Resident Day Report for NF Assessment Note: Assessment Quarter 3 - Resident Days October 1, 2024 - December 31, 20243 (Q87)3/4/2025
    RDR Submission*Due Date for Submission of Resident Day Report for NF Assessment Note: Assessment Quarter 4 - Resident Days January 1, 2025 - March 31, 20254 (Q88)5/2/2025
    Assessments**Due Date for NFs to Send ACH or Wire Transfers for Assessment Fees3 & 4 (Q87 & Q88)6/13/2025

    *Resident Day Reports not submitted by the established reporting deadline will result in penalties assessed as described inthe PA NF Assessment and Quarterly Resident Day Reporting Form End User Manual.

    **Assessment Payments not paid by the established deadline will result in interest assessed beginning the day after the Assessment payment is due. Quarterly Assessment payments must be a wire transfer or ACH Credit.

    Quarterly Assessment Payments

    Effective July 1, 2017, the Department of Human Services (Department) requires nursing facilities to remit their Quarterly Assessment Payments (QAPs) through the Automated Clearing House (ACH) Credit system and no longer accepts checks for QAPs.

    Nursing facilities are required to remit their QAPs by direct payment through the ACH Credit system. The Department has designated two acceptable ACH Credit transaction formats. The Cash Concentration Disbursement (CCD+) format accommodates one addenda record. The Corporate Trade Payment (CTX) format may be used for entities wishing to make payments for more than one nursing facility or for multiple QAPs for the same facility in the same transaction.

    Please reference the Nursing Facility Assessment End User Manual located at page 18 for detailed instructions.

    Assessments by Fiscal Year

    ​Assessment Basis for Fiscal Year 2020-2021

    The following nursing facilities will continue to be exempt from the Assessment Program under the methodology for FY 2020-2021:

    1. State-owned and operated nursing facilities.
    2. Veteran's Administration nursing facilities.
    3. Nursing facilities that provide nursing facility services free of charge to all residents.
    4. Newly licensed nursing facilities that have not been licensed and operated by the current or previous owner will be exempt until the nursing facility's days are included in the data used as the basis of the assessment. A nursing facility that changes ownership is not considered a newly licensed nursing facility for assessment purposes.

    The Department will continue to assess nonexempt nursing facilities at two rates. Under the methodology for FY 2020-2021, an assessment rate of $4.61 which represents a decrease of $2.69 from last year's rate will apply to the following five categories of nursing facilities:

    • County nursing facilities.
    • Nursing facilities that have 44 or fewer licensed beds.
    • Certain continuing care retirement community (CCRC) nursing facilities (see 40 Pa.B. 7297 (December 18, 2010)).
    • Nursing facilities with an MA occupancy rate of at least 94% based on Calendar Year (CY) 2018 resident days as of November 19, 2019. For the purpose of qualifying for the lower assessment rate, a nursing facility's MA occupancy rate will be calculated as follows: MA Occupancy Rate = Sum of Total PA MA Days from the CY 2018 resident days data ÷ Sum of Total Resident Days from the CY 2018 resident days data, rounded to two decimals.
    • Nursing facilities with at least 125,000 MA days and with an overall occupancy rate of 90% or higher based on the CY 2018 resident days as of November 19, 2019. For the purpose of qualifying for the lower assessment rate, a nursing facility's overall occupancy rate will be calculated as follows: Overall Occupancy Rate = Sum of Total Resident Days from CY 2018 resident days as of November 19, 2019 ÷ (number of licensed beds as of November 18, 2019 × 365), rounded to two decimals.

    For all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010 an assessment rate of $28.70 will apply which is a decrease of $2.69 from last year's rate.

    The Department estimates that the annual aggregate assessment fees for nonexempt nursing facilities will total $425.337 million. The Department will use the State revenue derived from the assessment fees and any associated FFP to support payments to qualified MA nursing facility providers in accordance with applicable laws and regulations.

    ​Assessment Basis for Fiscal Year 2020-2021

      The following nursing facilities will continue to be exempt from the Assessment Program under the methodology for FY 2020-2021:

      1. State-owned and operated nursing facilities.
      2. Veteran's Administration nursing facilities.
      3. Nursing facilities that provide nursing facility services free of charge to all residents.
      4. Newly licensed nursing facilities that have not been licensed and operated by the current or previous owner will be exempt until the nursing facility's days are included in the data used as the basis of the assessment. A nursing facility that changes ownership is not considered a newly licensed nursing facility for assessment purposes.

      The Department will continue to assess nonexempt nursing facilities at two rates. Under the methodology for FY 2020-2021, an assessment rate of $4.61 which represents a decrease of $2.69 from last year's rate will apply to the following five categories of nursing facilities:

      • County nursing facilities.
      • Nursing facilities that have 44 or fewer licensed beds.
      • Certain continuing care retirement community (CCRC) nursing facilities (see 40 Pa.B. 7297 (December 18, 2010)).
      • Nursing facilities with an MA occupancy rate of at least 94% based on Calendar Year (CY) 2018 resident days as of November 19, 2019. For the purpose of qualifying for the lower assessment rate, a nursing facility's MA occupancy rate will be calculated as follows: MA Occupancy Rate = Sum of Total PA MA Days from the CY 2018 resident days data ÷ Sum of Total Resident Days from the CY 2018 resident days data, rounded to two decimals.
      • Nursing facilities with at least 125,000 MA days and with an overall occupancy rate of 90% or higher based on the CY 2018 resident days as of November 19, 2019. For the purpose of qualifying for the lower assessment rate, a nursing facility's overall occupancy rate will be calculated as follows: Overall Occupancy Rate = Sum of Total Resident Days from CY 2018 resident days as of November 19, 2019 ÷ (number of licensed beds as of November 18, 2019 × 365), rounded to two decimals.

      For all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010 an assessment rate of $28.70 will apply which is a decrease of $2.69 from last year's rate.

      The Department estimates that the annual aggregate assessment fees for nonexempt nursing facilities will total $425.337 million. The Department will use the State revenue derived from the assessment fees and any associated FFP to support payments to qualified MA nursing facility providers in accordance with applicable laws and regulations.

      ​Assessment Basis for Fiscal Year 2019-2020

      The following nursing facilities will continue to be exempt from the Assessment Program in FY 2019-2020:

      1. State-owned and operated nursing facilities.
      2. Veteran's Administration nursing facilities.
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter in which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      The department will continue to assess nonexempt nursing facilities at two rates. One rate will apply to five categories of nursing facilities: 

      • County nursing facilities
      • Nursing facilities that have 44 or fewer licensed beds
      • Qualified nursing facilities affiliated with continuing care retirement communities (CCRC) — (see 40 Pa.B. 7297; Dec. 18, 2010)
      • Nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2017, and ending March 31, 2018, for each nursing facility as of Nov. 13, 2018
      • Nursing facilities with an overall occupancy rate of 90 percent or higher and at least 125,000 MA days based on the calendar year 207 resident days.

      The other rate will apply to all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010. Using the applicable rate, the department will calculate an annual assessment amount for each nonexempt facility by multiplying its assessment rate by the facility's historical non-Medicare resident day for the four consecutive assessment quarters beginning April 1, 2017, and ending March 31, 2018. The department will collect the annual assessment amount in four equal quarterly installments.

      The department will maintain the same rate structure for FY 2019-2020 as in FY 2018-2019, but the assessment rates represent a uniform decrease of 10 cents from the previous year's rates. For FY 2019-2020, the assessment rates for nonexempt nursing facilities will be as follows:

      1. For county nursing facilities, facilities that have 44 or fewer licensed beds, for qualified CCRC nursing facilities, and nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2017, and ending March 31, 2018, for each nursing facility as of Nov. 13, 2018, the assessment rate will be $7.30 per historical non-Medicare resident day.
      2. For all other nonexempt nursing facilities, the assessment rate will be $31.39 per historical non-Medicare resident day.

      ​ Assessment Basis for Fiscal Year 2018-2019

      The following nursing facilities will continue to be exempt from the Assessment Program in FY 2018-2019:

      1. State-owned and operated nursing facilities.
      2. Veteran's Administration nursing facilities.
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter in which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      The department will continue to assess nonexempt nursing facilities at two rates. One rate will apply to four categories of nursing facilities:

      • County nursing facilities
      • Nursing facilities that have 44 or fewer licensed beds
      • Qualified nursing facilities affiliated with continuing care retirement communities (CCRC) — (see 40 Pa.B. 7297; Dec. 18, 2010)
      • Nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2016, and ending March 31, 2017, for each nursing facility as of Nov. 13, 2017.

      The other rate will apply to all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010. Using the applicable rate, the department will calculate an annual assessment amount for each nonexempt facility by multiplying its assessment rate by the facility's historical non-Medicare resident day for the four consecutive assessment quarters beginning April 1, 2016, and ending March 31, 2017. The department will collect the annual assessment amount in four equal quarterly installments.

      The department will maintain the same rate structure for FY 2018-2019 as in FY 2017-2018, but the assessment rates represent a uniform decrease of 61 cents from the previous year's rates. For FY 2018-2019, the assessment rates for nonexempt nursing facilities will be as follows:

      1. For county nursing facilities, for nursing facilities that have 44 or fewer licensed beds, for qualified CCRC nursing facilities, and nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2016, and ending March 31, 2017, for each nursing facility as of Nov. 13, 2017, the assessment rate will be $7.40 per historical non-Medicare resident day.
      2. For all other nonexempt nursing facilities, the assessment rate will be $31.49 per historical non-Medicare resident day.

      ​Assessment Basis for Fiscal Year 2017-2018

      The following nursing facilities will continue to be exempt from the Assessment Program in FY 2017-2018:

      1. State-owned and operated nursing facilities
      2. Veteran's Administration nursing facilities
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter in which an assessment is collected
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      The department will continue to assess nonexempt nursing facilities at two rates. One rate will apply to four categories of nursing facilities:

      • County nursing facilities
      • Nursing facilities that have 44 or fewer licensed beds
      • Qualified nursing facilities affiliated with Continuing Care Retirement Communities (CCRC) — (see 40 Pa.B. 7297; Dec. 18, 2010)
      • Nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2015, and ending March 31, 2016, for each nursing facility as of April 22, 2016.

      The other rate will apply to all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010. Using the applicable rate, the department will calculate an annual assessment amount for each nonexempt facility by multiplying its assessment rate by the facility's historical non-Medicare resident day for the four consecutive assessment quarters beginning April 1, 2015, and ending March 31, 2016, and collect the annual assessment amount in four equal quarterly installments.

      The department will maintain the same rate structure for FY 2017-2018 as in FY 2016-2017. For FY 2017-2018, the assessment rates for nonexempt nursing facilities will be as follows:

      1. For county nursing facilities, for nursing facilities that have 44 or fewer licensed beds, for qualified CCRC nursing facilities, and nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2015, and ending March 31, 2016, for each nursing facility as of April 22, 2016, the assessment rate will be $8.01 per historical non-Medicare resident day.
      2. For all other nonexempt nursing facilities, the assessment rate will be $32.10 per historical non-Medicare resident day.

      ​ Assessment Basis for Fiscal Year 2016-2017

      The following nursing facilities will continue to be exempt from the Assessment Program in FY 2016-2017:

      1. State-owned and operated nursing facilities.
      2. Veteran's Administration nursing facilities.
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter in which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      The department will assess nonexempt nursing facilities at two rates. One rate will apply to four categories of nursing facilities:

      • County nursing facilities
      • Nursing facilities that have 44 or fewer licensed beds
      • Qualified nursing facilities affiliated with Continuing Care Retirement Communities (CCRC) — (see 40 Pa.B. 7297; Dec. 18, 2010)
      • Nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2015, and ending March 31, 2016, for each nursing facility as of April 22, 2016.

      The other rate will apply to all other nonexempt facilities, including nursing facilities that began participation in a CCRC on or after July 1, 2010. Using the applicable rate, the department will calculate an annual assessment amount for each nonexempt facility by multiplying its assessment rate by the facility's historical non-Medicare resident day for the four consecutive assessment quarters beginning April 1, 2015, and ending March 31, 2016, and collect the annual assessment amount in four equal quarterly installments.

      Although the department will maintain the same basic rate structure for FY 2016-2017, the department is increasing the assessment rate for nonexempt nursing facilities in the higher rate tier from the rates in FY 2016-2017. For FY 2016-2017, the assessment rates for nonexempt nursing facilities will be as follows:

      • For county nursing facilities, for nursing facilities that have 44 or fewer licensed beds, for qualified CCRC nursing facilities and nursing facilities with an MA occupancy rate of at least 94 percent based on the four consecutive assessment quarters beginning April 1, 2015, and ending March 31, 2016, for each nursing facility as of April 22, 2016, the assessment rate will be $8.01 per historical non-Medicare resident day.
      • For all other nonexempt nursing facilities, the assessment rate will be $32.10 per historical non-Medicare resident day. Assessment payments are due the last day of the assessment quarter or 30 days after publication of this second notice, whichever is later.

       

      ​Assessment Basis for Fiscal Year 2015-2016

      Nursing facilities will be exempt from payment of the assessment if they fall into any of the following categories:

      1. Government owned and operated nursing facilities
      2. Veterans Administration nursing facilities
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter for which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      As in the first five years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2015-2016 based on the number of licensed beds in the facility, the nursing facility's CCRC or county status, and the number of non-Medicare resident days during each calendar quarter immediately preceding the assessment quarter. During FY 2015-2016, the assessment rates for nonexempt facilities will be as follows:

      • The assessment rate for the county nursing facilities, nursing facilities that either have 44 or fewer licensed beds, grandfathered CCRC nursing facilities that have certified continued participation within the CCRC and any nursing facilities with an MA occupancy rate of at least 94 percent based on the latest four assessment quarters for each nursing facility as of Nov. 5, 2014, will be $8.01 per non-Medicare resident day.
      • The assessment rate for all other nonexempt nursing facilities will be $30.06 per non-Medicare resident day.

      ​Assessment Basis for Fiscal Year 2015-2016

      Nursing facilities will be exempt from payment of the assessment if they fall into any of the following categories:

      1. Government-owned and operated nursing facilities
      2. Veterans Administration nursing facilities
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter for which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      As in the first five years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2014-2015 based on the number of licensed beds in the facility, the nursing facility's CCRC or county status, and the number of non-Medicare resident days during each calendar quarter immediately preceding the assessment quarter. During FY 2014-2015, the assessment rates for nonexempt facilities will be as follows:

      • The assessment rate for the county nursing facilities, nursing facilities that either have 44 or fewer licensed beds and for grandfathered CCRC nursing facilities that have certified continued participation within the CCRC, will be $8.01 per non-Medicare resident day.
      • The assessment rate for all other nonexempt nursing facilities will be $29.46 per non-Medicare resident day.

      ​Assessment Basis for Fiscal Year 2013-2014

      Nursing facilities will be exempt from payment of the assessment if they fall into any of the following categories:

      1. Government-owned and operated nursing facilities
      2. Veterans Administration nursing facilities
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter for which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      As in the first five years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2013-2014 based on the number of licensed beds in the facility, the nursing facility's CCRC or, county status, and the number of non-Medicare resident days during each calendar quarter immediately preceding the assessment quarter. During FY 2013-2014, the assessment rates for nonexempt facilities will be as follows:

      • The assessment rate for the county nursing facilities, nursing facilities that either have 50 or fewer licensed beds and for grandfathered CCRC nursing facilities that have certified continued participation within the CCRC, will be $8.32 per non-Medicare resident day.
      • The assessment rate for all other nonexempt nursing facilities will be $29.77 per non-Medicare resident day.

      ​Assessment Basis for Fiscal Year 2012-2013

      Nursing facilities will be exempt from payment of the assessment if they fall into any of the following categories:

      1. Government-owned and operated nursing facilities
      2. Veterans Administration nursing facilities
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter for which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      As in the first five years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2012-2013 based on the number of licensed beds in the facility, the nursing facility's CCRC or county status, and the number of non-Medicare resident days during each calendar quarter immediately preceding the assessment quarter. During FY 2012-2013, the assessment rates for nonexempt facilities will be as follows:

      • The assessment rate for the county nursing facilities, nursing facilities that either have 50 or fewer licensed beds and for grandfathered CCRC nursing facilities that have certified continued participation within the CCRC, will be $8.09 per non-Medicare resident day.
      • The assessment rate for all other nonexempt nursing facilities will be $29.54 per non-Medicare resident day.

       

      Assessment Basis for Fiscal Year 2011-2012

      Nursing facilities will be exempt from payment of the assessment if they fall into any of the following categories:

      1. Government-owned and operated nursing facilities
      2. Veterans Administration nursing facilities.
      3. Nursing facilities that have not been licensed and operated by the current or previous owner for the full calendar quarter prior to the calendar quarter for which an assessment is collected.
      4. Nursing facilities that provide nursing facility services free of charge to all residents.

      As in the first 5 years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2011‐2012 based on the number of licensed beds in the facility, the nursing facility's CCRC or, county status, and the number of non‐Medicare resident days during each calendar quarter immediately preceding the assessment quarter. During FY 2011‐2012, the assessment rates for nonexempt facilities will be as follows:

      1. The assessment rate for county nursing facilities, nursing facilities that either have 50 or fewer licensed beds and for grandfathered CCRC nursing facilities that have certified continued participation within that CCRC, will be $6.59 per non‐Medicare resident day.
      2. The assessment rate for all other nonexempt nursing facilities will be $28.04 per non‐Medicare resident day.