Department of Human Services Notice

pa-56-26-908: Payments to nonpublic and county nursing facilities; proposed rates for State Fiscal Year 20262027

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Summary

This notice announces the Department of Human Services (Department) proposed annual case-mix per diem payment rates for State Fiscal Year (FY) 2026-2027 for nonpublic and county nursing facilities that participate in the Medical Assistance (MA) Program. Nonpublic Nursing Facility Per Diem Rates As required by the case-mix payment methodology in 55 Pa. Code Chapter 1187, Subchapter G (relating to rate setting), the Department intends to set an annual MA per diem rate for each nonpublic nursing facility provider. Each facility's annual per diem rate will have four components: resident care, other resident related, administrative and capital. For each quarter of FY 2026-2027, the Department will adjust the resident care component of each facility's rate by multiplying the resident care component by the facility's MA case-mix index for the appropriate picture date. In addition, in calculating the proposed rates, the Department assumes that the General Assembly will enact legislation authorizing the continued use of a budget adjustment factor (BAF) in setting MA payment rates for FY 2026-2027. 1 Upon reauthorization of the BAF, the Department will submit a State Plan Amendment to the Centers for Medicare & Medicaid Services to include the BAF formula which the Department will use in FY 2026-2027. A detailed description of the BAF formula is in the notice, Payment for Nursing Facility Services Provided by County and Nonpublic Nursing Facilities; Notice of Change in Methods and...

The agency’s own summary, as published.

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