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​Pennsylvania 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 Pennsylvania General Assembly in September, 2003. The General Assembly authorized the Department of Human Services (DHS) to collect this assessment from all non-governmental 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 (PA) MA facility and therapeutic leave days, PA MA hospital reserve days, PA MA managed care days, PA MA hospice days, Long Term Care Capitated Assistance Program (LTCCAP) days, PA MA pending days, other states' MA days, private pay days, 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 located at http://www.panfsubmit.com

Questions about the assessment program should be submitted to the Bureau of Finance, Division of Rate Setting and Auditing, NH Assessment Unit at (717) 787-1171.

Fiscal Years 2003-2004 and 2004-2005:

Pennsylvania Nursing Facility Assessment - Assesment Basis Fiscal Years 2003-2004 and 2004-2005:

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.

All other licensed nursing facilities will be assessed by the Department every quarter of the fiscal year. The assessment rate for a non-exempt nursing facility for each quarter of the calendar year will be determined as follows:

  1. If the non-exempt facility participates within a licensed Continuing Care Retirement Community or has 50 licensed beds or less, it will be assessed at $1.50 per non-Medicare resident day in the calendar quarter preceding the assessment quarter.
  2. All other non-exempt nursing facilities will be assessed at $15.91 per non-Medicare resident day in the calendar quarter preceding the assessment quarter.

Fiscal Year 2005-2006:

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 2 years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2005-2006 based on the number of licensed beds in the facility, the nursing facility's CCRC status and the number of non-Medicare resident days during each calendar quarter immediately preceding the assessment quarter. During FY 2005-2006, the assessment rates for nonexempt facilities will be as follows:

  1. The assessment rate for nonexempt nursing facilities that participate within a licensed CCRC or that have 50 licensed beds or less will be increased by $.04 to $1.54 per non-Medicare resident day.
  2. The assessment rate for all other nonexempt nursing facilities will be increased by $.04 to $15.95 per non-Medicare resident day.

Fiscal Year 2006-2007:

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 2 years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2006-2007 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 2006-2007, the assessment rates for nonexempt facilities will be as follows:

  1. The assessment rate for nonexempt facilities that either have 50 or fewer beds or that participate in a CCRC will be increased by $.43 to $1.97 per non-Medicare resident day.
  2. The assessment rate for all other nonexempt nursing facilities will be increased by $4.40 to $20.35 per non-Medicare resident day.

Fiscal Year 2007 - 2008:

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 4 years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2007 - 2008 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 2007 - 2008, the assessment rates for nonexempt facilities will be as follows:

  1. The assessment rate for county nursing facilities and for nonexempt facilities that either have 50 or fewer beds or that participate in a CCRC will be $2.40 per non-Medicare resident day.
  2. The assessment rate for all other nonexempt nursing facilities will be $24.83 per non-Medicare resident day.

Fiscal Year 2008 - 2009:

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 4 years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2008-2009 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 2008-2009, the assessment rates for nonexempt facilities will be as follows:

  1. The assessment rate for county nursing facilities and for nonexempt facilities that either have 50 or fewer beds or that participate in a CCRC will be $2.30 per non-Medicare resident day.
  2. The assessment rate for all other nonexempt nursing facilities will be $23.75 per non-Medicare.

Fiscal Year 2009-2010:

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 4 years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2009-2010 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 2009-2010, the assessment rates for nonexempt facilities will be as follows:

  1. The assessment rate for county nursing facilities and for nonexempt facilities that either have 50 or fewer beds or that participate in a CCRC will be $3.55 per non-Medicare resident day.
  2. The assessment rate for all other nonexempt nursing facilities will be $25.00 per non-Medicare resident day.

Fiscal Year 2010-2011:

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 4 years of the Assessment Program, nonexempt nursing facilities will continue to be assessed on a quarterly basis during FY 2010-2011 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 2010-2011, 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 $4.05 per non-Medicare resident day.
  2. The assessment rate for all other nonexempt nursing facilities will be $25.50 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.
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 5 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:

  1. 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.
  2. The assessment rate for all other nonexempt nursing facilities will be $29.54 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 5 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:

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

​Assessment Basis for Fiscal Year 2014-2015

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 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:

  1. 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.
  2. The assessment rate for all other nonexempt nursing facilities will be $29.46 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 5 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:

  1. 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% based on the latest 4 assessment quarters for each nursing facility as of November 5, 2014 will be $8.01 per non-Medicare resident day. 
  2.  The assessment rate for all other nonexempt nursing facilities will be $30.06 per 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 (December 18, 2010)); and nursing facilities with an MA occupancy rate of at least 94% 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:

(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% 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 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 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 (December 18, 2010)); and nursing facilities with an MA occupancy rate of at least 94% based on the 4 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% based on the 4 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 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 (December 18, 2010)); and nursing facilities with an MA occupancy rate of at least 94% based on the four consecutive assessment quarters beginning April 1, 2016, and ending March 31, 2017, for each nursing facility as of November 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 $0.61 from last 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% based on the four consecutive assessment quarters beginning April 1, 2016, and ending March 31, 2017, for each nursing facility as of November 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.

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.
 

Nursing Facility Assessment End User Manual (Updated 11/04/19)