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Nursing Facility ​Rates

Managed Care Minimum Payment Rates - State Directed Payment

On December 30, 2022 the Centers for Medicare and Medicaid Services approved a state-directed payment authorizing minimum payment rates to nursing faciliites in the Community HealthChoices managed care LTSS program. The minimum payment rates are effective with dates of services January 1, 2023 and later. The minimum payment rates consist of three parts:

    • The approved State Plan rate per diem as determined in accordanance with State Plan attachment 4.19 D;
    • A uniform rate per diem by provider class; and
    • A facility specific rate per diem by provider class

For each nursing facility, the sum of the three amounts equals the minimum rate at which a CHC-MCO must contract with the facility

Minimum Payment Rates Effective 4/1/2023
Minimum Payment Rates Effective 1/1/2023
Overview for Nonpublic Nursing Facilities 
Overview for County Nursing Facilities 
Days Used in 2023 Access to Care Estimate
Frequently Asked Questions

L
ong Term Care/Case Mix Rates

On Jan. 1, 1996, the Department of Human Services (DHS) implemented 55 PA. Code Chapter 1187, the Nursing Facilities Services Case-Mix Reimbursement System. Case-mix rates for all Medical Assistance (MA) nursing facilities' were determined in accordance with the conditions and limitations specified in 55 PA. Code Chapter 1187 and the commonwealth's Title XIX State Plan. Beginning, Fiscal Year 2006-07, DHS changed the rate-setting methodology for MA county nursing facilities and reimbursed the facilities in accordance with 55 PA. Code Chapter 1189, for county nursing facilities, which was adopted June 23, 2006, and became effective July 1, 2006.

This section includes the most recent proposed case-mix rates as well as final rates beginning January 1996. Click on the appropriate link below to initiate steps to view the rate information you are interested in. This information is updated as notification of the proposed and final rates is published in the Pennsylvania Bulletin.

Rate Files

The rate files are Excel spreadsheets and Microsoft Excel is needed to access these files. Some of these pages are large and contain a great deal of information — please be aware that they may require several minutes to load.

    • Proposed Rates — These are the most recent proposed case-mix rates.
    • Condensed Final Rates — These are the condensed versions of final case-mix rates. These documents consist of Provider Names, MA CMI Averages, and Final Rates.
    • Detailed Final Rates — These are full Excel spreadsheets for final case-mix rates. These spreadsheets consist of provider name, MA CMI averages, final rates, average per diems, peer group prices, limited prices, cost center rates, etc.

Additional Resources

Budget Adjustment Factor (BAF) Information

Crosswalk to Column Headings of Rate Spreadsheets

County Proposed Rates

Rate Year
County Proposed Rates
​2023-2024
​View 2023-2024 County Proposed Rates

County Final Rates

Rate Year

County Detailed Rates

​2023
View January 2023 to June 2023 County Detailed Rates
​2022
View July 2022 to December 2022 County Detailed Rates
​2021-2022
View 2021-2022 County Detailed Rates
​2020-2021
View 2020-2021 County Detailed Rates
​2019-2020View 2019-2020 County Detailed Rates

2018-2019

View 2018-2019 County Detailed Rates
2017-2018
View 2017-2018 County Detailed Rates
2016-2017View 2016-2017 County Detailed Rates
2015-2016View 2015-2016 County Detailed Rates
2014-2015View 2014-2015 County Detailed Rates
2013-2014View 2013-2014 County Detailed Rates
2012-2013View 2012-2013 County Detailed Rates
2011-2012View 2011-2012 County Detailed Rates
2010-2011
View 2010 2011 County Detailed Rates
2009-2010View 2009-2010 County Detailed Rates
2008-2009
View 2008-2009 County Detailed Rates
2007-2008View 2007-2008 County Detailed Rates
2006-2007View 2006-2007 County Detailed Rates


Nursing Facility Proposed Rates

Month/Year
​Condensed Rates
Detailed Rates
​July 2023
View Condensed Proposed Rates
View Detailed Proposed Rates

Nursing Facility Final Rates

Month/Year

Condensed Rates

Detailed RatesCrosswalk
​April 2023
View Condensed Rates
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​January 2023
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​October 2022
​View Condensed Rates
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​July 2022
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​April 2022
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​January 2022
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​October 2021
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​July 2021
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​April 2021
​View Condensed Rates
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​January 2021
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​October 2020
​View Condensed Rates
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​July 2020
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​April 2020
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​January 2020View Condensed RatesView Detailed Rates
​October 2019View Condensed Rates
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​July 2019View Condensed Rates
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April 2019View Condensed Rates
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January 2019View Condensed Rates
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October 2018View Condensed Rates
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July 2018View Condensed Rates
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April 2018View Condensed Rates
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January 2018View Condensed Rates
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October 2017View Condensed Rates
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July 2017View Condensed Rates
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April 2017View Condensed Rates
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January 2017View Condensed Rates
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October 2016View Condensed Rates
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July 2016 View Condensed Rates
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April 2016View Condensed Rates
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January 2016View Condensed Rates
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October 2015View Condensed Rates
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July 2015 View Condensed Rates
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April 2015View Condensed Rates
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January 2015View Condensed Rates
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October 2014View Condensed Rates
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July 2014 View Condensed Rates
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April 2014View Condensed Rates
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January 2014 View Condensed Rates
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October 2013 View Condensed Rates
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July 2013 View Condensed Rates
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April 2013 View Condensed Rates
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January 2013 View Condensed Rates
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Special Rehab Facility Final Rates

Month/YearCondensed RatesDetailed Rates
April 2012
ViewView
January 2012ViewView
November 2011ViewView

2023 One-Time Enhanced Supplemental Payment

List of Qualified Nursing Facilities