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PA Bulletin, Doc. No. 19-1425



Disproportionate Share and Supplemental Hospital Payments

[49 Pa.B. 5525]
[Saturday, September 21, 2019]

 The Department of Human Services (Department) is announcing its intent to allocate funds for Fiscal Year (FY) 2019-2020 inpatient disproportionate share hospital (DSH) payments to qualifying inpatient acute care general, psychiatric and rehabilitation hospitals and qualifying psychiatric and rehabilitation units of acute care general hospitals, outpatient supplemental payments to qualifying inpatient acute care general hospitals, direct medical education payments to qualifying inpatient acute care general hospitals and certain DSH and supplemental payments to new hospitals.

 The Department also intends to clarify in the State Plan the payment methodology for new hospitals eligible for Medical Assistance (MA) Dependency supplemental payments, as follows, to make the language consistent with the provisions for hospitals for which the Department has a FY 2014-2015 MA-336 Hospital Cost Report as of July 2017.

 The Department is not otherwise changing the State Plan provisions addressing the qualifying criteria or payment methodology for these payments. All payment limitations are 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.

New Hospital MA Dependency Payments

 For the MA Dependency Payment, the Department annualizes each new hospital's data for its initial fiscal year of enrollment to determine if the new hospital qualifies for this payment in accordance with the qualifying criteria for the payment as provided in the State Plan. For qualifying new hospitals enrolled as acute care general hospitals for which the Department does not have a FY 2014-15 MA-336 Hospital Cost Report as of July 2017, the Department will determine the payment amount for the first full fiscal year of enrollment by multiplying the number of Pennsylvania (PA) MA fee-for-services (FFS) acute care inpatient days that were provided by the new hospital during its initial FY of enrollment by either:

 I. $850 for qualifying hospitals with greater than 50,000 PA MA (FFS and managed care) acute care inpatient days during its initial FY of enrollment as provided by the new hospital.

 II. $370 for other qualifying new hospitals.

 III. New hospitals for which the Department has a FY 2014-15 MA-336 Hospital Cost Report as of July 2017 will not qualify for the MA Dependency payment as a new hospital.

Fiscal Impact

 The FY 2019-2020 impact, as a result of the funding allocation for these payments, is $258.953 million ($112.150 million in State general funds and $146.803 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-1366. (1) General Fund; (2) Implementing Year 2019-20 is $112,150,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$342,544,000; 2017-18 Program—$477,690,000; 2016-17 Program—$450,970,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 19-1425. Filed for public inspection September 20, 2019, 9:00 a.m.]

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