pa-56-38-1380: Payment for nursing facility services provided by nonpublic nursing facilities; Medical Assistance day one incentive payments to nonpublic nursing facilities for Fiscal Year 2026-2027

Summary

This announcement provides advance notice that the Department of Human Services (Department) intends to continue to make Medical Assistance Day One Incentive (MDOI) payments to qualified nonpublic nursing facilities for Fiscal Year (FY) 2026-2027. The MDOI payments to nonpublic nursing facilities will provide incentives to nonpublic nursing facilities to provide services to individuals who are Medical Assistance (MA) eligible on the day of admission. The MDOI payments are intended to encourage nonpublic nursing facilities to increase access to care for the poor and indigent citizens of this Commonwealth. Nonpublic MDOI Payments The Department will use the Total Pennsylvania Medical Assistance (PA MA) days and Total Resident Days as reported by nonpublic nursing facilities under Article VIII-A of the Human Services Code (62 P.S. §§ 801-A 815-A) 1 , regarding nursing facility assessments, to determine eligibility and calculate payments. To qualify for MDOI payments, the nursing facility must be a nonpublic nursing facility for the full Resident Day quarters ended December 31, 2019, and March 31, 2020, and have submitted the required resident day reports for those quarters. In addition, the nonpublic nursing facility shall have an overall occupancy rate of at least 85% and an MA occupancy rate of at least 65% during the applicable Resident Day quarter. A nursing facility's overall occupancy rate for these payments will be determined as follows: Overall occupancy rate = (Total...

The agency’s own summary, as published.