NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Establishment of an Additional Class of Disproportionate Share Payments
[36 Pa.B. 4793]
[Saturday, August 26, 2006]The Department of Public Welfare's (Department) intends to establish an additional class of disproportionate share hospital (DSH) payments for certain qualifying hospitals.
Effective August 29, 2005, the Department changed its acute care general hospital limit for its General Assistance (GA) Medical Assistance (MA) recipients to one admission per State fiscal year. Acute care general hospitals may continue to serve GA recipients, regardless of whether the GA recipient has exhausted the annual acute care general hospital admission benefit, even though hospitals may not be eligible for MA Program payment for the subsequent admission within the State fiscal year. Therefore, to ameliorate the anticipated increased level of uncompensated care that certain acute care general hospitals may incur, the Department is establishing a one-time additional DSH payment.
The Department intends to consider an acute care general hospital to be eligible for this additional class of DSH payment, if the acute care general hospital meets one of the following criteria:
a) The acute care general hospital's calculated cost of care for projected additional GA admissions is greater than the 75th percentile of the calculated cost for projected additional GA admissions for all acute care general hospitals.
b) The acute care general hospital is located in a rural area designated by Federal Office of Management and Budget and the acute care general hospital's calculated cost of care for projected additional GA admissions exceeds the 70th percentile of the calculated cost of care for projected additional GA admissions for all rural acute care general hospitals.
c) The acute care general hospital is eligible to receive a DSH payment under one of the following provisions of the Department's Medicaid State Plan:
1) Augmented Payments for Certain High Medical Assistance Hospitals.
2) Additional Class of Disproportionate Share Payments for hospitals which advance access to multiple types of medical care in economically distressed areas.
3) Additional Class of DSH Payments for hospitals that provide a high volume of services to MA eligible recipients and low-income populations in medically underserved areas.
4) Additional Class of DSH Payments for general acute care hospitals that provide high volume of MA acute care and psychiatric services that incur significant uncompensated care costs (pending CMS approval).
Payments to eligible acute care general hospitals will be made as follows:
a) Except for Academic Medical Centers, acute care general hospitals that are eligible for a payment under criterion c) above will be paid 75% of their calculated cost of care for projected additional GA admissions. Academic Medical Centers eligible for a payment under criterion c) above will be paid 50% of their calculated cost of care for projected additional GA admissions.
b) All remaining eligible acute care general hospitals will be paid their proportionate share of the available funds on the basis of the proportion of each acute care general hospital's calculated cost of care for projected additional GA admissions compared to the calculated cost of care for projected additional GA admissions of all remaining eligible acute care general hospitals.
c) All eligible acute care general hospitals will receive a one-time payment during fiscal year 2006-2007.
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
For Fiscal Year 2005-2006, the fiscal impact as a result of this additional class of DSH payments will be $22.247 million in total funds ($10 million in State General funds and $12.247 million in Federal funds). This program will be funded for 1 year only.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: 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 AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-482. (1) General fund; (2) Implementing year 2005-06 is $10 million; (3) 1st Succeeding Year 2006-07 is $0; 2nd Succeeding Year 2007-08 is $0; 3rd Succeeding Year 2008-09 is $0; 4th Succeeding Year 2009-10 is $0; 5th Succeeding Year 2010-11 is $0; (4) 2004-05 Program--$531.785 million; 2003-04 Program--$411.042 million; 2002-03 Program--$407.104 million; (7) Medical Assistance--Long-Term Care; (8) recommends adoption.
[Pa.B. Doc. No. 06-1696. Filed for public inspection August 25, 2006, 9:00 a.m.]
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