NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Additional Class of Payments to Qualifying Acute Care General Hospitals for Obstetrical and Neonatal Intensive Care Services
[39 Pa.B. 1362]
[Saturday, March 14, 2009]The purpose of this notice is to announce the Department of Public Welfare (Department) intends to allocate funding for Fiscal Year (FY) 2008-2009 for an additional class of disproportionate share hospital (DSH) payments for certain qualifying hospitals based on obstetrical and neonatal intensive care cases. The Department also intends to amend the payment methodology applicable to rural hospitals for these DSH payments. There will be no change to the qualifying criteria for determining eligibility for these payments or the payment methodology for nonrural hospitals.
The proposed payment methodology for rural hospitals that meet the qualifying criteria is:
(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 Pennsylvania (PA) Medical Assistance (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).
(F) For rural hospitals located in counties whose ratio of MA eligible persons to total county population exceeds one standard deviation above the mean for all rural counties but less than 1.3 standard deviations above the mean for all rural counties, multiply the product in clause (E) by 1.50. For rural hospitals located in counties whose ratio of MA eligible persons to total county population is equal to or greater than 1.3 standard deviations above the mean for all rural counties but less than 1.6 standard deviations above the mean for all rural counties, multiply the product in clause (E) by 1.75. For rural hospitals located in counties whose ratio of MA eligible persons to total county population is equal to or greater than 1.6 standard deviations above the mean for all rural counties, multiply the product in clause (E) by 2.0.
(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).
(F) For rural hospitals located in counties whose ratio of MA eligible persons to total county population exceeds one standard deviation above the mean for all rural counties but less than 1.3 standard deviations above the mean for all rural counties, multiply the product in clause (E) by 1.50. For rural hospitals located in counties whose ratio of MA eligible persons to total county population is equal to or greater than 1.3 standard deviations above the mean for all rural counties but less than 1.6 standard deviations above the mean for all rural counties, multiply the product in clause (E) by 1.75. For rural hospitals located in counties whose ratio of MA eligible persons to total county population is equal to or greater than 1.6 standard deviations above the mean for all rural hospitals, multiply the product in clause (E) by 2.0.
(iii) 15% of the funds available for rural hospitals will be distributed equally among qualified rural hospitals with obstetrical cases for PA MA recipients.
(iv) To ensure that payments do not exceed available funds, the Department may adjust payments to each hospital to receive its proportionate share of the available funds.
In making these payments, the Department will ensure that no acute care general hospital will receive any DSH payment that is in excess of its hospital specific DSH upper payment limit and the Commonwealth will not exceed its aggregate annual DSH allotment.
Fiscal Impact
The FY 2008-2009 fiscal impact, as a result of this additional class of DSH payments is $14.389 million ($6.544 million in State General Funds and $7.845 million in Federal Funds) upon approval by the Centers for Medicare and Medicaid Services.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department at the following address: 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 Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-587. (1) General Fund; (2) Implementing Year 2008-09 is $6.544 M; (3) 1st Succeeding Year 2009-10 is $0.000 M; 2nd Succeeding Year 2010-11 is $0.000 M; 3rd Succeeding Year 2011-12 is $0.000 M; 4th Succeeding Year 2012-13 is $0.000 M; 5th Succeeding Year 2013-14 is $0.000 M; (4) 2007-08 Program--$5 M; 2006-07 Program--$0 M; 2005-06 Program--$0 M; (7) Obstetric and Neonatal Services; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 09-485. Filed for public inspection March 13, 2009, 9:00 a.m.]
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