Assessment Program Questions and Answers
Q. We are a nursing facility (NF) that will pay no assessment fee and will not receive a supplemental payment. Are we still required to fill out the Resident Day Reporting Form (RDR)?
A. Yes. You must always complete the RDR form even if there were 100% Medicare days for the entire quarter.
Q. Is it necessary for the Administrator of the NF to sign the Signature on File (SOF) form or may another principle sign?
A. It is preferable that the Administrator signs the form but another responsible person within the NF or a Corporate Officer can sign. It is necessary for a new form to be submitted if the responsibility for the accuracy of the days is changed from one person to another. You can find the SOF at: dhs.pap.gov and www.PANFSubmit.com
Q. When can I begin to report days on the Website?
A. Each fiscal year as soon as the Final Public Notice has been issued and assessment rates are approved, you may begin to report your days. The schedule of due dates, known as the Important Dates Chart for each quarter will be published at: dhs.pa.gov and www.PANFSubmit.com. For new NFs who are reporting as a first time user, as soon as Department of Human Services has received your SOF and you have received your logon ID and password from Myers and Stauffer, you may log in at www.PANFsubmit.com to report the days. On an ongoing basis, you may begin to report days as soon as the Resident Day Quarter has ended, which would be the first day of the Assessment Quarter.
Q. How many days do we have to complete the submission of the resident days?
A. To view deadline for resident day reporting, please review The Important Dates Chart at: dhs.pa.gov and www.PANFsubmit.com,it will provide the submission and payment due dates for each Assessment Quarter.
Q. Can we report quarters early?
A. Yes, you may report resident days prior to the deadline, but the supplemental and assessment payments will follow the posted schedule. The NF Assessment and Supplemental Payment Dates are listed at: dhs.pa.gov and www.PANFsubmit.com. On an ongoing basis, you may begin reporting days as soon as the Resident Day Quarter has ended, which would be the first day of the Assessment Quarter.
Q. How do I determine what resident day quarter I am submitting for?
A. For example, April 1, 2014 through June 30, 2014 is the first Assessment Quarter. The resident days reported for this Assessment Quarter are from the prior quarter January 1, 2014 through March 31, 2014.
Q. How can I tell if my information has been accepted into the Website?
A. If you, the provider, are able to generate a bill the data has been received.
Q. Are out-of-state residents included in the assessment?
A. Each resident in NF, regardless of whom is paying the daily rate must be reported on the RDR form. Other states' MA residents are recorded on line 10 of the RDR Form "Other States' MA Days," and counted as "Total Other Days." An assessment is applied to each day. These days are NOT counted as a Pennsylvania MA day.
Q. How are HMO Medicare days reported? (For instance Security Blue)
A. HMO Medicare days are reported on line 14 of the RDR Form as Medicare days.
Q. Are LIFE days reported as MA Days?
A. Yes, LIFE days are reported on line 6 of the RDR Form which are carried down and included in the Total MA Days.
Q. How are Hospice Respite Days for a Non-MA facility reported?
A. Hospice Respite Days for a non-MA facility are reported on line 14 of the RDR Form as Medicare Days.
Q. How is a Hospice Day reported?
A. For an MA facility, hospice days are reported on line 7 of the RDR Form, "PA MA Hospice Days." For non-MA facilities, refer to the previous question. Be careful not to report the same day in two lines of the RDR Form. The day should be categorized dependent on who is paying the room and board (R&B). In this particular question if someone other than Department of Human Services is paying the R&B – for instance a Commercial insurance plan – NH Assessment Unit does not want this to be included as MA.
Q. A NF determined a day to be classified as a Medicare Part A day but later was denied by Medicare. Because of the timing, the NF is responsible for six days. How is this reported?
A. NFs should include the resident on the correct line of the RDR Form according to how they were reported on the census on the day the census report was generated. This date is recorded on line 2 of the RDR Form, "Based On Census Records As Of."
Q. How do we report MA pending days?
A. Report MA pending days from past quarters on the appropriate line on the RDR Form according to the known payor source on the census date and not the status during the RDR. Days are counted as MA pending days if you have submitted the MA600L – the MA Financial Eligibility Application for LTC form request to the County Assistance Office and reasonably expect that the request for MA eligibility will be approved. It is anticipated that these MA pending Days will be monitored closely to determine fluctuations or high reporting incidences.
Q. In reporting days for last year, do we report as a pending day if an MA600L was approved but never paid?
A. If the provider still anticipates that MA will pay for the day of care after the claim has been submitted, report the days on line 3 of the RDR Form, "PA MA Facility & Therapeutic Leave Days." Any resident day, whether currently paid or not, needs to be reported.
Q. What if pending days are not pended to the date originally anticipated?
A. Documentation of why the date changed is recommended. It is anticipated that these days will be closely monitored.
Q. We may not have the information for pending days at the end of the quarter. How do we make corrections?
A. Any pending days you have, as long as the MA600L is submitted to the CAO, should be reported as MA Pending Days. Use your best judgment and document. Do not duplicate residents and do not report them on more than one line of the RDR Form. Corrections from an already submitted quarter cannot be changed and should not be corrected when completing the RDR Form for subsequent quarters.
Q. What about private pay bed hold days?
A. If the facility reports the private pay resident on their census, whether they receive payment for the bed hold day or not, they are reported as private pay days on line 11 of the RDR Form.
Q. If a home office has two NFs, are they required to use the CTX format for ACH payment?
A. The home office could choose to make two CCD+ transactions or use CTX if making both payments at the same time or making multiple quarters' payments for the same facility. Refer to page 18 of the NF Assessment End User Manual located at: http://www.dhs.state.pa.us/provider/longtermcarecasemixinformation/assessment/index.htm and www.PANFsubmit.com
Q. We are currently set up to receive money from Department of Human Services electronically. Does that mean we are set up to send ACH credit transactions for our assessment?
A. No. The payments received from Department of Human Services are a debit transaction. You need to contact your bank to set up the ACH Credit transaction.
Q. How will I receive my supplemental payments?
A. You will receive your supplemental payments via a remittance advice (RA).
Q. What are the criteria for a NF to receive supplemental payments?
A. The Department will pay quarterly supplemental payments to qualified NF for each state fiscal year.
To qualify for a quarterly supplemental payment a NF must:
· Meet the definition of a general NF as defined in 55 Pa. Code § 1187.2.
· Have participated continuously in the MA Program during the entire corresponding assessment quarter.
· Have reported the information requested by the Department in the manner and time period specified by the Department for the corresponding assessment quarter.
· Supplementals will not be paid to those facilities that have not paid their assessment.
A NF that is no longer participating in the MA Program on the day on which the supplemental payment is being made will still be eligible to receive a supplemental payment so long as, in addition to meeting the criteria above, the facility has paid the assessment amount due to the Department for the corresponding assessment quarter.
Q. How are the allowable costs and supplemental calculated?
A. The allowable cost portion = (quarterly assessment payment / total resident days) x Total MA days. The supplemental portion = (Total MA days) x (the supplemental per diem).
Q. A facility would like to do the pre-note test for ACH and wants to know what to put in the bill number.
A. Use "0000000008." This test bill number correlates with the 8th assessment quarter for a test facility with a Facility ID of 00000000. Put this test bill number where the bill number would go in the addenda portion of the transaction.
Q. Are checks acceptable if we are unable to set up the ACH Credit on time through the bank?
A. Due to an increasing number of checks getting lost in transmit or not being submitted in a timely fashion, the Department is strongly encouraging nursing facilities to remit their Quarterly Assessment Payments (QAP's) by direct payment through the Automated Clearing House (ACH) Credit system. It is recommended that you obtain ACH Credit Services at least four weeks prior to your first payment since financial institutions may have lengthy set up and qualifying requirements. Receipt of QAP's by the Commonwealth may be verified by viewing the history page for your facility on the www.PANFSubmit.com website. The Payment Received column will identify the date the payment was received. Additional information in regards to setting up an ACH transaction can be found page 18 of the End User's Manual, which can be located at: dhs.pap.gov and www.PANFsubmit.com.Should an emergency arise which prevents a payment from being transmitted, contact the Department to make arrangements for an alternate payment format.
Q. If a NF cannot acquire ACH Credit services from the bank due to a facility's credit issues, are wire transfers permitted?
A. Yes a wire transfer would be an acceptable payment format.
Q. Why is there no due date on the bill? The bill states "by the due date."
A. Please refer to the Important Date Chart link at: dhs.pa.gov and www.PANFsubmit.com for quarterly assessment due dates.
Q. Is there a way to correct information reported on the Website once submitted?
A. If an error has been made after the RDR form was submitted; the NF should mail or fax a letter indicating the reason to have the days corrected along with documentation. After NH Assessment Unit has received the information, the corrections will be made in the database, the assessment and supplemental will be recalculated and you will be notified of any over or underpayment to be resolved. Under no circumstances will an exception be granted if the request is more than one year from the remittance date for which the allowable cost and supplemental cost was originally paid.
Q. When there is a Change of Ownership (CHOW), who is responsible for completing the RDR and making the Assessment Payment?
A. See page 21, End User Manual, when an Assessed NF undergoes a CHOW, it is the obligation of the owner of the facility at the time the RDR Form and QAP are due to submit the RDR and make the payment.
Q. A CHOW occurred in 2011. Only the building was purchased and no records were transferred to the new owner. Would the 2010 records need to be obtained or can I file from the day I took over?
A. When an Assessed NF undergoes a CHOW, it is the obligation of the owner of the facility at the time the RDR Form and QAP are due to submit the form and make the payment. The sales agreement between the current and prior owners should address the accessibility to records. The new owner is required to report the RDR Form for the assessment quarters covering the periods prior to the CHOW. The NH Assessment Unit is not involved in this process.
Q. A NF had a bed change 12/31/10. Will the NF get an error message since the information for the bed size doesn't match the first quarter?
A. No. The ending licensed bed size reported for one quarter does not have to match the ending licensed bed size of a prior quarter. However, if the bed size change has not yet been recorded in the NF Assessment database, the facility will receive a warning message, but the NF can submit their RDR Form. The warning message was established to alert providers when a potential keying error has been made.
Q. Will the assessment information be audited?
A. There will be a method of monitoring. You are responsible to keep all documentation supporting the days submitted. State Plan in section Supplemental Payments located at I.2. g "states that the information furnished by each qualified NF is subject to audit verification by the Department".
Q. What if we are a CCRC and are not recognized as a CCRC in the Assessment Program?
A. A written request should be submitted to DPW and should include any supporting documentation. The NF must meet the following criteria:
· The NF is owned or controlled by an entity that is certified as a CCRC by the Insurance Department.
· The CCRC provides a continuum of care during the assessment period that includes residential living units that are either occupied or available for immediate occupancy.
· In addition to being owned and controlled by the certified CCRC entity, the NF must be:
o located on the same campus as the CCRC's residential living units ; or
o identified in the CCRC's Disclosure Statement and Resident Agreement under the Continuing-Care Provider Registration and Disclosure Act and located no more than 30 miles from the campus on which the CCRC's residential living units are located.
Under these guidelines, a NF that is owned or controlled by a CCRC which is planning to construction residential living units in the future, or is constructing residential units, but which has no residential units occupied or available for immediate occupancy, would not qualify for the CCRC assessment rate.
Effective July 1, 2010, the Department is no longer accepting requests for a NF to be a CCRC.
Q. How is the supplemental per diem calculated?
A. The formula is outlined in the State Plan and is as follows:
1. The Department will estimate the amount available for supplemental payments by subtracting from the assessment revenue the amount necessary to maintain NF payment rates and the amount necessary to reimburse MA allowable costs related to the assessment.
2. The available statewide supplemental revenue will then be divided by the most recent statewide MA days available to determine the supplemental per diem amount.
3. The supplemental per diem amount will then be multiplied by the qualified NF's quarterly MA days as reported by the facility for the corresponding assessment quarter. The product of this calculation will be the qualified NF's quarterly supplemental payment.
Q. How was the 44-bed cutoff determined for payment of a reduced assessment per diem amount?
A. This is the cutoff that was needed to meet the statistical test required by CMS for a non-uniform assessment program.
Q. A resident of a NF has Long Term Care insurance that provides for a portion of the stay (in one case $160/day). The remaining portion of the per diem is picked up by Medical Assistance (MA). In this particular case, $109 would be billed to MA. Should this be counted as a private pay day or should it be counted as an MA day for purposes of the assessment?
A. Assuming the resident is MA, and assuming the Department and the resident's third party payor are each contributing a share of the NF's MA payment rate, the day would be reported as an MA day due to the fact that both the Department and the resident pay 100% of the MA rate for an MA resident. Whether the resident pays in cash or has cash benefits assignment from a Long Term Care Policy insurance coverage, it is still regarded as the MA resident's portion of the payment, and would be counted as an MA day.
Q. A resident in a NF is Medicare qualified. However, if the resident is receiving payments from insurance as a result of an automobile accident or a workman's comp, how should these days be counted?
A. More info is needed, but it is assumed the question is whether these are Medicare days which are exempt from assessment. The answer will depend not on whether the resident is eligible for Medicare but whether Medicare is paying for the day of care. If a private insurance company pays for the day of care, the resident would be reported on line 11 of the RDR Form, Private Pay and Other Days.