55 Pa. Code § 1181.59 – Payment to a nursing facility for heavy care/intermediate services or intermediate care provided in a dually certified skilled bed.

(a) Payment may be made to a nursing facility for intermediate care provided in a bed which is dually certified for skilled and intermediate care, subject to the following conditions:
1. (1) The costs of services to the intermediate care (ICF) patients in dually certified beds, including services to heavy care/intermediate patients, shall be included in the determination of the skilled nursing facility (SNF) payment rate.
2. (2) The SNF payment rate shall be based on the costs of care of all patients served in dually-certified and SNF-only certified beds.
3. (3) Except as provided in subsection (b), payments for ICF patients in the dually-certified beds will be determined by the facility’s rate for ICF-only certified beds, or, where the facility has no ICF-only certified beds, by combining the facility’s SNF rate components for depreciation and interest on capital indebtedness with the lower of one of the following:
  1. (i) The facility’s SNF net operating cost rate component.
  2. (ii) The applicable ceiling on ICF net operating costs.
4. (4) The facility has contacted the Department, prior to invoicing for intermediate care in the bed, to designate the bed as an intermediate care bed for MA program payment purposes.
5. (5) Payment will not be made for services to an ICF patient in a bed which is not certified to provide intermediate care.
(b) Payment may be made to a nursing facility for heavy care/intermediate services when a recipient’s level of care changes to heavy care/intermediate if that recipient is in a dually certified skilled bed. The nursing facility shall be reimbursed for heavy care/intermediate services at the higher of the facility’s applicable rates for skilled or intermediate care, as limited by the ceilings.

Authority

The provisions of this § 1181.59 amended under sections 201 and 443.1(2) of the Public Welfare Code (62 P. S. § § 201 and 443.1(2)).

Source

The provisions of this § 1181.59 codified July 24, 1981, effective July 25, 1981, 11 Pa.B. 2610; amended August 5, 1983, effective January 1, 1983, 13 Pa.B. 2402; amended September 6, 1985, effective September 7, 1985, except that the groups and ceilings shall be effective and apply to costs of services rendered from July 1, 1984 through December 31, 1984, 15 Pa.B. 3181; amended March 10, 1989, effective immediately and applies retroactively to February 23, 1988, 19 Pa.B. 999. Immediately preceding text appears at serial page (117425).

Cross References

This section cited in 55 Pa. Code § 1181.52 (relating to payment conditions).