NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Intention to Establish an Additional Class of Disproportionate Share Payments for Obstetrical and Neonatal Intensive Care Services
[38 Pa.B. 1405]
[Saturday, March 22, 2008]The purpose of this notice is to announce the Department of Public Welfare's (Department) intends to establish a one-time additional class of disproportionate share hospital (DSH) payments for certain qualifying hospitals based on obstetrical and neonatal intensive care cases.
The Commonwealth is dedicated to ensuring the availability of quality care to low-income pregnant woman and children. Special programs exist within the Medical Assistance (MA) Program to provide benefits for pregnant woman and as a result, approximately one of every three births within this Commonwealth is covered by MA. Access to obstetrical and neonatal health care services across this Commonwealth is necessary for all MA recipients and is crucial to ensure a positive prenatal experience for the mother and the best outcome for the infant. Maintaining the system for obstetrical and neonatal health care services, the Department will make a one-time additional type of disproportionate share payment to hospitals that meet certain qualifying criteria.
A rural hospital, which is defined as being located in a county outside a Metropolitan Statistical Area (MSA) established by the United States Office of Management and Budget or is the only hospital licensed by the Department of Health (DOH) to provide obstetrical services located in a county of the 6th, 7th or 8th class, must meet one of the following qualifying criteria to be eligible for the DSH payments:
(a) The hospital is licensed to provide neonatal intensive care services;
(b) The hospital is licensed to provide obstetrical services and ranks in the top 1/3 of rural hospitals in terms of volume of obstetrical cases for Pennsylvania (PA) MA recipients during the most recent fiscal year with available data;
(c) The hospital is licensed to provide obstetrical services and has greater than 50% of all of its obstetrical cases for PA MA recipients during the most recent fiscal year with available data; or
(d) The hospital is the only hospital licensed to provide obstetrical services within the county.
A nonrural hospital must be licensed to provide obstetrical and/or neonatal intensive care services and must meet one of the following qualifying criteria to be eligible for the DSH payments:
(a) The hospital ranks in the top 1/3 of nonrural hospitals in terms of volume of obstetrical cases for PA MA recipients during the most recent fiscal year with available data;
(b) The hospital has greater than 50% of all of its obstetrical cases for PA MA recipients during the most recent fiscal year with available data;
(c) The hospital provides obstetrical care services and is located within 5 miles of any hospital that closed its obstetrical service during the previous 3 years;
(d) The hospital ranks in the top 1/3 of nonrural hospitals in terms of volume of neonatal intensive care cases for PA MA recipients during the most recent fiscal year with available data;
(e) The hospital has greater than 50% of all of its neonatal intensive care cases for PA MA recipients during the most recent fiscal year with available data; or
(f) A children's hospital with greater than 40% of all of its cases for PA MA recipients during the most recent fiscal year with available data.
The Department will make a one-time additional class of DSH payments to those hospitals that meet the qualifying criteria using the following payment methodology:
(a) 15% of the total amount available will be paid to qualified rural hospitals as follows:
(i) Of the amount available for distribution to rural hospitals, 75% will be distributed to qualified rural hospitals with obstetrical cases for PA MA recipients using the following formula:
(A) For each hospital, determine the ratio of the hospital's obstetrical cases for PA MA recipients to all obstetrical cases for the hospital.
(B) For each hospital, multiply the ratio under clause (A) by the number of the hospital's obstetrical cases for PA MA recipients.
(C) Add the products under clause (B) for all hospitals.
(D) Divide the amount available for distribution to rural hospitals, by the sum under clause (C).
(E) Multiply the quotient under clause (D) by the product under clause (B).
(ii) Of the amount available for distribution to rural hospitals, 10% will be distributed to qualified rural hospitals with neonatal intensive care cases for PA MA recipients using the following formula:
(A) For each hospital, determine the ratio of the hospital's neonatal intensive care cases for PA MA recipients to all neonatal intensive care cases for the hospital.
(B) For each hospital, multiply the ratio under clause (A) by the number of the hospital's neonatal intensive care cases for PA MA recipients.
(C) Add the products under clause (B) for all hospitals.
(D) Divide the amount available for distribution to rural hospitals by the sum under clause (C).
(E) Multiply the quotient under clause (D) by the product under clause (B).
(iii) 15% of the funds available for rural hospitals will be distributed equally among qualified rural hospitals with obstetrical cases for PA MA recipients.
(b) 85% of the total amount available will be paid to qualified nonrural hospitals as follows:
(i) Of the 85%, 52.5% will be distributed to qualified nonrural hospitals with obstetrical cases for PA MA recipients covered by medical assistance using the following formula:
(A) For each hospital, determine the ratio of the hospital's obstetrical cases for PA MA recipients to all obstetrical cases for the hospital.
(B) For each hospital, multiply the ratio under clause (A) by the number of the hospital's obstetrical cases for PA MA recipients.
(C) Add the products under clause (B) for all hospitals.
(D) Divide the amount available for distribution to nonrural hospitals by the sum under clause (C).
(E) Multiply the quotient under clause (D) by the product under clause (B).
(ii) Of the amount available for distribution to nonrural hospitals, 32.5% will be distributed to qualified nonrural hospitals with neonatal intensive care cases for PA MA recipients using the following formula:
(A) For each hospital, determine the ratio of the hospital's neonatal intensive care cases for PA MA recipients to all neonatal intensive care cases for the hospital.
(B) For each hospital, multiply the ratio under clause (A) by the number of the hospital's neonatal intensive care cases for PA MA recipients.
(C) Add the products under clause (B) for all hospitals.
(D) Divide the amount available for distribution to nonrural hospitals by the sum under clause (C).
(E) Multiply the quotient under clause (D) by the product under clause (B).
(iii) Of the amount available for distribution to nonrural hospitals, 15% will be distributed equally among qualified nonrural hospitals with obstetrical cases for PA MA recipients.
Fiscal Impact
The Fiscal Year 2007-2008 fiscal impact, as a result of this one-time additional class of DSH payments is $10,888,502 ($5.0 million in State General Funds and $5,888,502 in Federal Funds upon approval by the Centers for Medicare and Medicaid Services). Additional future payments will be based on continued funding appropriation to the MA Program for this additional class of DSH payments.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-546. (1) General Fund; (2) Implementing Year 2007-08 is $5,000,000; (3) 1st Succeeding Year 2008-09 is $0; 2nd Succeeding Year 2009-10 is $0; 3rd Succeeding Year 2010-11 is $0; 4th Succeeding Year 2011-12 is $0; 5th Succeeding Year 2012-13 is $0; (4) 2006-07 Program--$0; 2005-06 Program--$0; 2004-05 Program--$0; (7) MA--Obstetric and Neonatal Services; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 08-517. Filed for public inspection March 21, 2008, 9:00 a.m.]
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