New Class of Disproportionate Share Payments
[47 Pa.B. 2159]
[Saturday, April 8, 2017]
The Department of Human Services (Department) is announcing its intent to create a new class of disproportionate share hospital (DSH) payments for qualifying Medical Assistance (MA) enrolled acute care general hospitals to promote access to acute care services for MA eligible persons in less urban areas of this Commonwealth.
For a hospital to qualify for this DSH payment, it must meet all of the following criteria, based on its State Fiscal Year (FY) 2013-2014 MA-336 Hospital Cost Report available to the Department as of October 2016 unless otherwise specified:
a) The hospital is enrolled in the MA Program as a general acute care hospital.
b) The hospital is located in a city of the third class, as defined in the Pennsylvania Manual (Volume 121) with a population of at least 25,000 persons, based on the 2010 Census.
c) The hospital has at least 150 beds.
d) The hospital reported an Inpatient Low-Income Utilization Rate of at least 20.0%.
e) The hospital's ratio of uncompensated care to net patient revenue was higher than 3.75%, based on the Pennsylvania Health Care Cost Containment Council's Financial Analysis 2015, Volume One.
The Department will determine a qualifying hospital's payment amount for this class of DSH payments by dividing the hospital's MA inpatient days by the total MA inpatient days for all qualifying hospitals and multiplying that percentage by the total amount allocated for these payments. The Department will use data from the FY 2013-2014 MA-336 Hospital Cost Report for this calculation.
All payment limitations are still applicable, including those limitations that the Commonwealth may not exceed its aggregate annual DSH allotment and that no hospital may receive DSH payments in excess of its hospital-specific limit.
The FY 2016-2017 impact, as a result of the creation of the new class of DSH payments, is $0.622 million ($0.300 million in State general funds and $0.322 million in Federal funds) upon approval by the Centers for Medicare & Medicaid Services.
Interested persons are invited to submit written comments regarding these payments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. The Department will review and consider all comments received within 30 days of this notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
Fiscal Note: 14-NOT-1126. (1) General Fund;
(7) MA—Academic Medical Centers; (2) Implementing Year 2016-17 is $500,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are $0; (4) 2015-16 Program—$17,431,000; 2014-15 Program—$17,431,000; 2013-14 Program—$16,831,000;
(7) MA—Fee-for-Service; (2) Implementing Year 2016-17 is $9,930,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are $0; (4) 2015-16 Program—$392,918,000; 2014-15 Program—$546,772,000; 2013-14 Program—$428,041,000;
(7) MA—Physician Practice Plans; (2) Implementing Year 2016-17 is $1,500,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are $0; (4) 2015-16 Program—$9,571,000; 2014-15 Program—$9,071,000; 2013-14 Program—$9,071,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 17-588. Filed for public inspection April 7, 2017, 9:00 a.m.]
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