Appeal from the Order of the Office of Hearings and Appeals of the Department of Public Welfare in case of Appeal of: Liberty Nursing Center, File No. 24-80-29, dated March 26, 1981.
Donald E. Wieand, Jr., Roberts, Traud, Wallitsch & Corkery, for petitioner.
Jeffrey Gonick, Assistant Counsel, for respondent.
Judges Rogers, Williams, Jr. and Barbieri, sitting as a panel of three. Opinion by Judge Rogers.
[ 80 Pa. Commw. Page 323]
Liberty Nursing Center (Liberty) is a skilled nursing facility providing care to a monthly average of ten or less medical assistance patients and is reimbursed pursuant to regulations promulgated by the Department of Public Welfare (DPW). Section III-G-2 of the Medical Assistance Program Manual for Allowable Cost Reimbursement for Skilled Nursing and Intermediate Care Facilities provides an option for a facility, like Liberty, with a monthly average of ten or less medical assistance patients to negotiate a prospective per diem rate with DPW. The regulation states that:
2. Determining a cost-related prospective rate for certain facilities.
As an alternative to having a current interim per diem rate subject to annual adjustment to allowable, reasonable costs under this Manual, a facility with a monthly average of ten Medical Assistance patients or less may negotiate a prospective per diem rate with the Department. Payments under prospective rate will not be subject to annual cost reporting or year-end adjustment under the Medical Assistance Program.
[ 80 Pa. Commw. Page 324]
The prospective rate, negotiated prior to the beginning of the Department's fiscal year, will be based on a facility's financial statements and other third party payer audit reports, if available. The established per diem rate will be effective July 1 and remain in effect through June 30 of each year.
A prospective rate for a facility will not exceed the Department's established ceilings. However, prospective rates for facilities will not be included in the rate used to establish ceiling computations.
Section III-G-2 was promulgated by DPW pursuant to its rule-making authority as set forth at Sections 201(2), 403(b) and 443.1(3) of the Public Welfare Code, Act of June 13, 1967, P.L. 31, as amended, 62 P.S. §§ 201(2), 403(b) and 443.1(3) ...