NOTICES
DEPARTMENT OF
HUMAN SERVICES
Disproportionate Share Payments and Supplemental Hospital Payments to Qualifying Hospitals
[49 Pa.B. 7541]
[Saturday, December 21, 2019]The Department of Human Services (Department) is announcing its intent to allocate funds in Fiscal Year (FY) 2019-2020 for several classes of inpatient disproportionate share payments and supplemental payments to Medical Assistance (MA) enrolled, qualifying inpatient acute care general hospitals. The Department does not intend to otherwise change 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 disproportionate share hospital (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.
Allocation of Funds
The Department intends to allocate $29.529 million ($14.100 million in State general funds and $15.429 million in Federal funds) for DSH payments to critical access and qualifying rural hospitals upon approval by the Centers for Medicare & Medicaid Services (CMS).
The Department intends to allocate $9.293 million ($4.437 million in State general funds and $4.856 million in Federal funds) for DSH payments to qualifying acute care general hospital burn centers upon approval by CMS.
The Department intends to allocate $13.992 million ($6.681 million in State general funds and $7.311 million in Federal funds) for DSH payments to qualifying acute care general hospitals providing obstetrical and neonatal services upon approval by CMS.
The Department intends to allocate $23.730 million ($11.331 million in State general funds and $12.399 million in Federal funds) for DSH payments to qualifying acute care general hospitals that qualify as academic medical centers upon approval by CMS.
The Department intends to allocate $14.637 million ($6.989 million in State general funds and $7.648 million in Federal funds) for DSH payments to qualifying acute care general hospitals that serve the indigent population of cities in this Commonwealth with an average per capita income significantly below the Statewide average upon approval by CMS.
The Department intends to allocate $0.524 million ($0.250 million in State general funds and $0.274 million in Federal funds) for DSH payments to qualifying acute care general hospitals that, in partnership with an independent facility listed as a Cleft and Craniofacial Team by the American Cleft Palate-Craniofacial Association, provide surgical services to patients with cleft palate and craniofacial abnormalities upon approval by CMS.
The Department intends to allocate $8.482 million ($4.050 million in State general funds and $4.432 million in Federal funds) for DSH payments to qualifying acute care general hospitals to provide additional support for the operation of academic medical programs through the medical education of health care professionals needed to treat the MA population upon approval by CMS.
The Department intends to allocate $5.864 million ($2.800 million in State general funds and $3.064 million in Federal funds) for DSH payments to qualifying acute care general hospitals to promote the availability of professional medical services to MA populations in less urbanized areas of this Commonwealth by supporting medical education and academic medical programs upon approval by CMS.
The Department intends to allocate $0.500 million ($0.239 million in State general funds and $0.261 million in Federal funds) for DSH payments to qualifying teaching hospitals that provide psychiatric services to MA beneficiaries to help offset medical education costs of psychiatrists that are incurred by hospitals providing assistance to MA beneficiaries and uninsured persons upon approval by CMS.
The Department intends to allocate $1.659 million ($0.792 million in State general funds and $0.867 million in Federal funds) for DSH payments to qualifying acute care general hospitals that provide a high volume of services to MA and low-income populations upon approval by CMS.
The Department intends to allocate $0.838 million ($0.400 million in State general funds and $0.438 million in Federal funds) for DSH payments to qualifying acute care general hospitals that have a low commercial-payer ratio, a negative trend in their net patient revenue and are located in an area of this Commonwealth with a disproportionate need for MA services to promote continued access to care for the MA population upon approval by CMS.
The Department intends to allocate $7.330 million ($3.500 million in State general funds and $3.830 million in Federal funds) for DSH payments to qualifying acute care general hospitals that participate in an academic medical program upon approval by CMS.
The Department intends to allocate $1.571 million ($0.750 million in State general funds and $0.821 million in Federal funds) for DSH payments to qualifying acute care general hospitals to promote access to acute care services for MA eligible persons in less urban areas of this Commonwealth upon approval by CMS.
The Department intends to allocate $9.425 million ($4.500 million in State general funds and $4.925 million in Federal funds) for DSH payments to qualifying acute care general hospitals that provide a high volume of services to the MA population to promote continued access to inpatient and ancillary outpatient services in this Commonwealth and to support academic medical programs that provide integrated patient-centered medical services upon approval by CMS.
The Department intends to allocate $3.142 million ($1.500 million in State general funds and $1.642 million in Federal funds) for supplemental payments to qualifying acute care general hospitals that provide a high volume of services to MA and low-income populations in medically underserved areas to promote the hospitals' continued participation in the MA Program upon approval by CMS.
The Department intends to allocate $0.900 million ($0.371 million in State general funds and $0.529 million in Federal funds) for supplemental payments to qualifying acute care general hospitals that provide a substantial portion of their inpatient services to MA beneficiaries upon approval by CMS.
Fiscal Impact
The FY 2019-2020 impact, as a result of the funding allocation for these payments, is $131.416 million ($62.690 million in State general funds and $68.726 million in Federal funds).
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-1380. (1) General Fund;
(7) MA—Fee-for-Service; (2) Implementing Year 2019-20 is $11,341,000; (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—Critical Access Hospitals; (2) Implementing Year 2019-20 is $14,100,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$10,400,000; 2017-18 Program—$6,997,000; 2016-17 Program—$6,997,000;
(7) MA—Hospital-Based Burn Centers; (2) Implementing Year 2019-20 is $4,437,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$3,782,000; 2017-18 Program—$3,782,000; 2016-17 Program—$3,782,000;
(7) MA—Obstetric and Neonatal Services; (2) Implementing Year 2019-20 is $6,681,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$3,681,000; 2017-18 Program—$3,681,000; 2016-17 Program—$3,681,000;
(7) MA—Academic Medical Centers; (2) Implementing Year 2019-20 is $23,681,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$24,681,000; 2017-18 Program—$24,681,000; 2016-17 Program—$21,181,000;
(7) MA—Physician Practice Plans; (2) Implementing Year 2019-20 is $2,000,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$10,071,000; 2017-18 Program—$10,071,000; 2016-17 Program—$10,071,000;
(7) Autism Intervention; (2) Implementing Year 2019-20 is $450,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$30,842,000; 2017-18 Program—$27,669,000; 2016-17 Program—$22,496,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 19-1907. Filed for public inspection December 20, 2019, 9:00 a.m.]
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