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Posts tagged "Bureau of Hearings and Appeals"

BHA Hearing Delays and Requesting Interim Assistance

Historically, the Bureau of Hearings and Appeals (BHA) has prioritized the scheduling and adjudication of Medical Assistance (MA) eligibility appeals over other types of appeals. Recently, however, beneficiaries and providers have experienced significant delays in the resolution of MA eligibility appeals. In some instances, the BHA is taking several months to schedule hearings on MA eligibility determinations. Generally, the BHA must take "final administrative action" within 90 days of the filing date of the appeal. "Final administrative action" means a decision by the hearing officer. If final administrative action is not taken within 90 days of the filing of the appeal, the Department of Human Services is required to authorize the payment of MA benefits to the provider on behalf of the resident pending the final administrative action. Interim assistance is not subject to restitution absent an affirmative misrepresentation by the beneficiary. In cases where the beneficiary is responsible for delaying the hearing process, the time limit for final administrative action is extended by the length of the delay.

DPW Publishes Case Mix Rates for 2014-2015

On September 20, 2014, the Department of Public Welfare published a notice in the Pennsylvania Bulletin regarding final case mix rates for state fiscal year 2014-2015.  Nursing facilities have received letters detailing their rates for that fiscal year.  Most notably, the budget adjustment factor continues to limit the estimated statewide day-weighted average payment rate for county and nonpublic nursing facilities so that the average payment rate in effect for the fiscal year is limited to the amount appropriated by the state legislature for funding.  For the July, October, in January rates, the base budget adjustment factor is .84265.  At the minimum, providers should review their rate notice letters to determine the cost report years DPW is using to set the facility's case-mix rates.  If the provider has an audit appeal pending for one of its base years, then the best practice would be to file an appeal of the case-mix rate notice to preserve any issue regarding the add-back of costs to the base year and subsequent recalculation of the payment rate.  Providers have 33 days from the date of the letter to file a request for hearing with the Bureau of Hearings and Appeals.

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