NOTICES
DEPARTMENT OF
HUMAN SERVICES
Disproportionate Share and Supplemental Hospital Payments
[48 Pa.B. 5926]
[Saturday, September 22, 2018]The Department of Human Services (Department) is announcing its intent to allocate funds for Fiscal Year (FY) 2018-2019 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 is also announcing its intent to modify eligibility criteria, payment methodologies and funding allocation for the Medical Assistance (MA) Dependency supplemental payment, including for new hospitals.
The Department is not otherwise changing its approved 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.
MA Dependency Payments
To qualify for these supplemental payments, an acute care general hospital must provide at least 40,000 total (Fee-for-Service (FFS) and managed care) days of inpatient care to Commonwealth MA beneficiaries as identified in the FY 2014-2015 MA-336 Hospital Cost Report available to the Department as of July 2017.
The Department will determine a qualifying hospital's annual payment amount by multiplying the number of the hospital's Commonwealth MA FFS acute care inpatient days, as identified in the FY 2014-2015 MA-336 Hospital Cost Report available to the Department as of July 2017 by either:
a) $850 for qualifying hospitals with greater than 50,000 total Commonwealth MA (FFS and managed care) acute care inpatient days.
b) $370 for other qualifying hospitals.
The Department will distribute payments to qualifying hospitals adjusted to reflect the total amount allocated per fiscal year for this payment.
New Hospitals
As a result of the change to the eligibility criteria for the MA Dependency Payment, the Department is modifying the eligibility of new hospitals for this payment. For purposes of determining the eligibility of a new hospital for the MA Dependency Payment, a new hospital is defined as a hospital that enrolled in the Pennsylvania MA Program on or after July 1, 2015, and for which the Department does not have a FY 2014-2015 MA-336 Hospital Cost Report as of July 2017.
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 2014-2015 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 PA MA FFS acute care inpatient days that were provided by the new hospital during its initial fiscal year of enrollment by either:
I. $850 for new hospitals with greater than 50,000 PA MA FFS acute care inpatient days during its initial fiscal year of enrollment as provided by the new hospital.
II. $370 for other qualifying new hospitals.
New hospitals for which the Department has a fiscal year 2014-2015 MA-336 Hospital Cost Report as of July 2017 will not qualify for the MA Dependency payment as a new hospital.
Fiscal Impact
For FY 2018-2019, the Department will allocate an annualized funding allocation of $256.564 million ($122.509 million in State general funds and $134.055 million in Federal funds) for direct medical education, inpatient disproportionate share and outpatient supplemental payments upon approval by the Centers for Medicare & Medicaid Services.
For FY 2018-2019, the Department will allocate an annualized funding allocation of $36.544 million ($17.450 million in State general funds and $19.094 million in Federal funds) for MA Dependency payments upon approval by the Centers for Medicare & Medicaid Services.
For FY 2018-2019, the Department will allocate an annualized funding allocation of $3.082 million ($1.472 million in State general funds and $1.610 million in Federal funds) for new hospital inpatient disproportionate share and supplemental payments upon approval by the Centers for Medicare & Medicaid Services.
Public Comment
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. 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).
TERESA D. MILLER,
SecretaryFiscal Note: 14-NOT-1276. (1) General Fund; (2) Implementing Year 2018-19 is $141,431,000; (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—FFS; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 18-1501. Filed for public inspection September 21, 2018, 9:00 a.m.]
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