Section 1602-T. Medical assistance payments for institutional care.
Notwithstanding section 443.1(7)(iv) of the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code:
(1) Payments to county and nonpublic nursing facilities enrolled in the medical assistance program as providers of nursing facility services shall be determined in accordance with the methodologies for establishing payment rates for county and nonpublic nursing facilities specified in the Department of Human Services's regulations and the Commonwealth's approved Title XIX State Plan for nursing facility services in effect after June 30, 2007. The following shall apply:
(i) Subject to Federal approval of such amendments as may be necessary to the Commonwealth's approved Title XIX State Plan, the Department of Human Services shall apply a revenue adjustment neutrality factor to county and nonpublic nursing facility payment rates so that the estimated Statewide day-weighted average payment rate in effect for that fiscal year is limited to the amount permitted by the funds appropriated by the General Appropriation Act for the fiscal year. The Department of Human Services shall apply the revenue adjustment neutrality factor as follows:
(A) The revenue adjustment neutrality factor shall remain in effect until the sooner of June 30, 2028, or the date on which a new rate-setting methodology for medical assistance nursing facility services which replaces the rate-setting methodology codified in 55 Pa. Code Chs. 1187 (relating to nursing facility services) and 1189 (relating to county nursing facility services) takes effect.
(B) Beginning on January 1, 2027, the Department of Human Services shall apply a revenue adjustment neutrality factor of not less than 0.86 to nonpublic nursing facility rates.
((i) amended July 12, 2026, P.L.265, No.21)
(ii) Subject to Federal approval as may be necessary, the following shall apply to nonpublic and county nursing facility payment rates, to the extent funds are appropriated for the purpose of rate increases for increased direct resident care requirements and resident care and related costs:
(A) Beginning January 1, 2023, the Department of Human Services shall make capitation payments to medical assistance Community HealthChoices managed care organizations that include amounts exclusively for the purpose of making payments to nonpublic nursing facilities and county nursing facilities as provided under clause (B)(I).
(B) The Department of Human Services shall adopt a minimum payment rate for payments for services rendered to medical assistance recipients under the Community HealthChoices program, effective with dates of service of January 1, 2023, through December 31, 2025, as follows:
(I) Community HealthChoices managed care organizations shall apply no less than the minimum payment rate to make payments to nonpublic nursing facilities and county nursing facilities for services rendered to medical assistance recipients under the Community HealthChoices program.
(II) The minimum payment rate shall be greater than or equal to the following amounts:
(a) For nonpublic nursing facilities, the nursing facility case-mix rates calculated in accordance with 55 Pa. Code Ch. 1187 and the Commonwealth's approved Title XIX State Plan in effect for the dates of service.
(b) For county nursing facilities, the county nursing facility rates in accordance with 55 Pa. Code Ch. 1189 and the Commonwealth's approved Title XIX State Plan in effect for the dates of service.
(2) (Reserved).
(1602-T added July 11, 2022, P.L.540, No.54)
Compiler's Note: See section 36(1) of Act 21 of 2026 in the appendix to this act for special provisions relating to retroactivity.