NOTICES
DEPARTMENT OF
HUMAN SERVICES
Disproportionate Share Payments to Qualifying Hospitals
[49 Pa.B. 7541]
[Saturday, December 21, 2019]The Department of Human Services (Department) is announcing its intent to allocate funding for Fiscal Year (FY) 2019-2020 disproportionate share hospital (DSH) payments made to qualifying Medical Assistance (MA) enrolled acute care general hospitals which provide a high volume of inpatient services to MA eligible and low income populations and is amending qualifying criteria to align language with the MA-336 Hospital Cost Report. These payments are intended to promote access to medically necessary inpatient services for MA eligible and low-income persons. The Department does not intend to otherwise change the qualifying criteria or payment methodology for these payments.
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.
The allocation of the funds for DSH payments described as follows is contingent on the availability of Federal financial participation for these payments.
Qualifying Criteria
A hospital is eligible for this additional class of DSH payments if the hospital meets all criteria listed as follows. Unless otherwise stated, the source of the information is the FY 2011-2012 MA-336 Hospital Cost Report.
a) The hospital is enrolled in the MA Program as an acute care general hospital.
b) The hospital is located in a county with a total population of less than 500,000 residents, based on the 2010 Federal decennial census.
c) The hospital has at least 400 total beds available.
d) The hospital ranked at or above the 90th percentile, among MA enrolled acute care hospitals located in counties with a total population of less than 500,000 residents, on the total number of MA inpatient days of care provided.
e) The hospital ranked in excess of one standard deviation above the mean among MA enrolled acute care hospitals located in counties with a total population of less than 500,000 residents, on the ratio of MA psychiatric inpatient days provided to total psychiatric inpatient days.
f) The hospital's ratio of uncompensated care to net patient revenue, based on the Pennsylvania Health Care Cost Containment Council's Financial Analysis 2013, exceeded 3.40%.
Fiscal Impact
The FY 2019-2020 impact, as a result of the funding allocation for these payments, is $0.730 million ($0.349 million in State general funds and $0.381 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).
TERESA D. MILLER,
SecretaryFiscal Note: 14-NOT-1379. (1) General Fund; (2) Implementing Year 2019-20 is $349,000; (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. 19-1906. Filed for public inspection December 20, 2019, 9:00 a.m.]
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