NOTICES
Disproportionate Share Payments for Enhanced Access to Emergency Department Services and Emergency Department and Outpatient Access Supplemental Payments
[44 Pa.B. 7967]
[Saturday, December 20, 2014]The Department of Human Services (Department) intends to amend the Commonwealth's Title XIX State Plan (State Plan) to establish a new class of disproportionate share hospital (DSH) payments for certain acute care general hospitals that will be funded with revenues generated through the hospital assessment imposed by the City of Philadelphia (City).
Background
On July 4, 2008, the General Assembly enacted Article VIII-E of the Public Welfare Code (62 P. S. §§ 801-E—808-E) to authorize the City to impose, by ordinance, a monetary assessment on the non-Medicare net operating revenue of acute care general hospitals located in the City for purposes of assuring access to hospital and emergency department services. The City passed an ordinance implementing a Hospital Assessment Program (Program) effective January 1, 2009, and the Program has been in place since that time. The Program generates additional revenues to fund Medical Assistance (MA) expenditures for hospital emergency department and other hospital services in Philadelphia. The Program also generates additional funding to support the City's public health clinics. The MA funding from the Hospital Assessment Program is currently being used to fund emergency department and outpatient access supplemental payments as approved by the Centers for Medicare and Medicaid Services (CMS).
This new class of DSH payments will also be funded by the Philadelphia assessment and is intended to help offset the costs incurred by acute care general hospitals in the City that provide a significant amount of emergency services to MA patients. Many emergency department patients are subsequently admitted to the hospital. To promote access to these critical hospital and emergency services, the Department intends to allocate a portion of the funding currently being allocated to the existing emergency department and outpatient access supplemental payment to this new class of DSH payments.
The Department intends to submit a State Plan Amendment to CMS to implement this new class of DSH payments for acute care general hospitals located in the City with emergency departments that provide at least 1,000 emergency department visits to Pennsylvania MA patients per year. Hospitals that furnish acute care inpatient services to patients who are predominantly under 18 years of age or hospitals that receive a disproportionate share payment for enhanced access to multiple types of medical care in economically distressed areas of this Commonwealth under the State Plan will not be eligible to receive this additional payment. The Department intends to distribute the additional payments to qualifying acute care general hospitals based on each qualifying hospital's historical MA inpatient Title XIX fee-for-service revenue using Fiscal Year 2011-2012 MA cost report data. Payments to a qualifying hospital under the State Plan will be limited to the amount permitted by the hospital's OBRA 93 hospital-specific limit. The Department intends to limit the maximum payment amount to 2.91% of the hospital's net patient revenue.
Since qualification for the new DSH payment is also related to MA patients seen in hospital emergency departments, a hospital eligible to receive the new DSH payment will not be eligible to receive an emergency department and outpatient access supplemental payment. For this reason, the Department intends to modify the criteria to qualify for the emergency department and outpatient access supplemental payment outlined in the State Plan to reflect this change as well as to modify the amount of funds to be allocated for this payment. All other qualifying criteria and the payment methodology for the current emergency department and outpatient access supplemental payment will remain unchanged.
Fiscal Impact
The Department anticipates there will be no fiscal impact as a result of these payments.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, Attention: 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).
BEVERLY D. MACKERETH,
SecretaryFiscal Note: 14-NOT-927. (1) General Fund;
(7) MA—Outpatient; (2) Implementing Year 2014-15 is $76,840,000; (3) 1st Succeeding Year 2015-16 through 5th Succeeding Year 2019-20 are $0; (4) 2013-14 Program—$264,179,000; 2012-13 Program—$450,835,000; 2011-12 Program—$645,095,000;
(7) MA—Inpatient; (2) Implementing Year 2014-15 is $76,840,000; (3) 1st Succeeding Year 2015-16 through 5th Succeeding Year 2019-20 are $0; (4) 2013-14 Program—$163,862,000; 2012-13 Program—$268,112,000; 2011-12 Program—$325,685,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 14-2640. Filed for public inspection December 19, 2014, 9:00 a.m.]
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