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PA Bulletin, Doc. No. 18-1867



Disproportionate Share Payments to Qualifying Hospitals

[48 Pa.B. 7463]
[Saturday, December 1, 2018]

 The Department of Human Services (Department) is announcing its intent to allocate funds for Fiscal Year (FY) 2018-2019 disproportionate share hospital (DSH) payments to certain Medical Assistance (MA) acute care general hospitals which, in partnership with an independent facility listed as a Cleft and Craniofacial Team by the American Cleft Palate-Craniofacial Association, provide surgical services to patients with cleft palate and craniofacial abnormalities. These payments are intended to promote access to inpatient hospital services for MA eligible and uninsured persons in this Commonwealth with cleft palate and craniofacial abnormalities.

Qualifying Criteria

 The Department will determine a hospital eligible for this additional class of disproportionate share payments if the hospital meets all of the following criteria. Unless otherwise stated, the source of the information is the State FY 2010-2011 MA hospital cost report (MA-336).

 a) The hospital is enrolled in the MA Program as a general acute care hospital and is licensed to provide obstetrical and neonatal services as reported by the Department of Health for the period July 1, 2010, through June 30, 2011.

 b) The hospital has a partnership with a facility listed as of January 2013 as a cleft palate team and a craniofacial team by the American Cleft Palate-Craniofacial Association and Cleft Palate Foundation.

 c) As of March 2013, the hospital is accredited as a Level I Adult Trauma Center and a Level I Pediatric Trauma Center by the Pennsylvania Trauma System Foundation.

 d) The hospital provided more than 135,000 total acute inpatient days of care.

 e) The hospital ranked at or above the 90th percentile for all enrolled acute care hospitals based on the total number of MA inpatient days of care.

 f) The hospital's ratio of uncompensated care to net patient revenue is at least 3.30%, based on the Pennsylvania Health Care Cost Containment Council's Financial Analysis 2012, Volume One.

Payment Determination

 Payments will be divided proportionally among qualified hospitals based on each hospital's total MA inpatient days to total MA inpatient days for all qualified hospitals. 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. Any funds available due to the application of the hospital-specific DSH upper payment limit will be redistributed to other hospitals qualifying under this class of disproportionate share payments on a proportionate basis.

Fiscal Impact

 The FY 2018-2019 impact, as a result of the funding allocation for these payments, is $0.524 million ($0.250 million in State general funds and $0.274 million in Federal funds) upon approval by the Centers for Medicare & Medicaid Services.

Public Comment

 Interested persons are invited to submit written comments regarding this notice 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 comments received within 30 days in determining the final payment methodology for these payments.

 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-1285. (1) General Fund; (2) Implementing Year 2018-19 is $250,000; (3) 1st Succeeding Year 2019-20 through 5th Succeeding Year 2023-24 are $0; (4) 2017-18 Program—$477,690,000; 2016-17 Program—$450,970,000; 2015-16 Program—$392,918,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 18-1867. Filed for public inspection November 30, 2018, 9:00 a.m.]

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