NOTICES
DEPARTMENT OF
HUMAN SERVICES
New Class of Disproportionate Share Hospital Payments
[47 Pa.B. 916]
[Saturday, February 11, 2017]The Department of Human Services (Department) is announcing its intent to create a new class of disproportionate share hospital (DSH) payments for qualifying Medical Assistance (MA) enrolled 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. The payment is intended to promote continued access to care for the MA population.
Qualifying Criteria
For a hospital to qualify for this DSH payment, it must meet all of the following criteria, based on its State Fiscal Year (FY) 2013-2014 MA-336 Hospital Cost Report, unless otherwise specified:
(1) The hospital is located in a city of the first class, as defined in the Pennsylvania Manual (Volume 121).
(2) The hospital's 3-year average change in net patient revenue for FYs 2012—2015 is negative according to the Pennsylvania Health Care Cost Containment Council's Fiscal Year 2015 Financial Analysis.
(3) The hospital's commercial-payer ratio, defined as 100% minus the hospital's Medicare share of net patient revenue for FY 2015 (expressed as a percent) minus the hospital's MA share of net patient revenue for FY 2015 (expressed as a percent), is more than one standard deviation lower than the mean for all acute care hospitals in the Pennsylvania Health Care Cost Containment Council's Fiscal Year 2015 Financial Analysis.
(4) The hospital does not qualify for payment under State Plan Amendment 4.19A, page 21z.
Payment Determination
Payments will be divided proportionally among qualifying hospitals based on the percentage of each qualifying hospital's inpatient MA days to the total inpatient MA days of all qualifying hospitals. 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 DSH limit. The Department will not redistribute DSH payments made under this additional class of DSH payments to qualifying hospitals as a result of a qualifying hospital exceeding its hospitals-specific DSH limit.
Fiscal Impact
The FY 2016-2017 impact, as a result of the funding allocation for these payments, is $1.244 million ($0.600 million in State general funds and $0.644 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 all 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).
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-1111. (1) General Fund; (2) Implementing Year 2016-17 is $600,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are $0; (4) 2015-16 Program—$392,918; 2014-15 Program—$564,772; 2013-14 Program—$428,041; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 17-248. Filed for public inspection February 10, 2017, 9:00 a.m.]
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