Current through Register Vol. 54, No. 24, June 15, 2024
Section 1187.108 - Gross adjustments to nursing facility payments(a) The case-mix payment system is a prospective system. There is no cost settlement under the case-mix payment system.(b) Certain adjustments may be made which increase or decrease the payment which a nursing facility may have otherwise received. Gross adjustments to nursing facility payments are based on one or more of the following general provisions: (1) If audit findings result in changing the peer group median and the peer group price, a retrospective gross adjustment is made for each nursing facility in the peer group where the change occurred.(2) If a nursing facility's MA CMI changes as a result of UMR resident assessment audit adjustments, retrospective gross adjustments shall be made for the nursing facility involved.(c) Specific adjustments of the gross payments received by a nursing facility may be required by §§ 1187.109-1187.115. This section cited in 55 Pa. Code § 1187.141 (relating to nursing facility's right to appeal and to a hearing).