NOTICES
DEPARTMENT OF
HUMAN SERVICES
Supplemental Payments to Qualifying Hospitals
[52 Pa.B. 1192]
[Saturday, February 19, 2022]The Department of Human Services (Department) is announcing its intent to allocate funds for fiscal year (FY) 2021-2022 to establish a new class of supplemental payment to qualifying acute care general hospitals located in a county with an estimated general population count of less than 1 million that serve a high percent of Medical Assistance (MA) patients. These payments will enable the continuation of quality medical services in these areas.
Qualifying Criteria
A hospital is eligible for these supplemental payments if the hospital meets all the following criteria. Unless otherwise stated, the source of the information is the FY 2018-2019 MA-336 Hospital Cost Report, as available to the Department on June 22, 2021.
a) The hospital is enrolled in the Commonwealth's MA Program as an acute care general hospital and submitted a FY 2018-2019 MA-336 Hospital Cost Report to the Department available to the Department on June 22, 2021;
b) The hospital provides an array of inpatient services (acute, psychiatric and rehabilitation) to MA enrollees as evidenced by having provided at least one acute care day, one psychiatric day and one rehabilitation day to MA beneficiaries;
c) The hospital's main campus is located in a county with an Annual Estimate of the Resident Population for 2019 of less than 1 million according to the United States Census Bureau, Population Division (March 2020 release date);
d) The hospital's combined fee-for-service (FFS) and managed care Pennsylvania MA inpatient acute care days exceeds the Statewide average combined FFS and managed care Pennsylvania MA inpatient acute care days for all hospitals enrolled in the MA Program as an acute care general hospital;
e) The hospital's Medicaid Inpatient Utilization Rate (MIUR) exceeds 30% (for purposes of this eligibility criterion a hospital's MIUR is equal to the hospital's total combined FFS and managed care MA inpatient days divided by the hospital's total inpatient days);
f) The hospital's inpatient Low Income Utilization Rate exceeds 30%; and,
g) The hospital's operating margin is less than 1.0% based on the Pennsylvania Health Care Cost Containment Council's FY 2019 Financial Analysis.
Payment Methodology
Payments will be divided proportionately among qualified hospitals based on each hospital's FFS Pennsylvania MA inpatient acute care days to total FFS Pennsylvania MA inpatient acute care days for all qualifying hospitals.
Fiscal Impact
For FY 2021-2022, the Department will allocate an annualized amount of $4.828 million in total funds (State and Federal) for these supplemental payments 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 Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1496. (1) General Fund;
(7) MA—Fee-for-Service; (2) Implementing Year 2021-22 is $682,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $0; (4) 2020-21 Program—$808,350,000; 2019-20 Program—$344,107,000; 2018-19 Program—$342,544,000;
(7) MA—Physician Practice Plans; (2) Implementing Year 2021-22 is $1,303,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $0; (4) 2020-21 Program—$9,618,000; 2019-20 Program—$7,502,000; 2018-19 Program—$10,071,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 22-286. Filed for public inspection February 18, 2022, 9:00 a.m.]
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