NOTICES
DEPARTMENT OF
HUMAN SERVICES
Supplemental Payments to Qualifying Hospitals
[54 Pa.B. 7635]
[Saturday, November 23, 2024]The Department of Human Services (Department) is announcing its intent to allocate funds in Fiscal Year (FY) 2024-2025 to establish a new class of supplemental payments to qualifying Medical Assistance (MA) enrolled acute care general hospitals that have a negative operating margin, high MA share of net patient revenue (NPR), low commercial NPR and are located in an area of this Commonwealth with a disproportionate need for MA services.
Qualifying Criteria
A hospital is eligible for these supplemental payments if the hospital is enrolled in the Pennsylvania MA Program as an acute care general hospital and meets all criteria listed as follows. Unless otherwise stated, the source of the information is the FY 2021-2022 MA-336 Hospital Cost Report available to the Department as of July 10, 2024.
(1) The hospital is located in a city of the first class.
(2) The hospital provides acute inpatient services to patient populations predominantly 18 years of age or older. A hospital's patient population is predominantly 18 years of age or older if the hospital's number of discharges for ''0—17 Years'' is less than 50% of the hospital's number of ''Total'' discharges. Discharges are determined from the calendar year 2022 Pennsylvania (PA) Department of Health Reports 3-A and 3-B.
(3) The hospital's FY 2023 operating margin is negative according to the PA Health Care Cost Containment Council's FY 2023 Financial Analysis, Volume 1.
(4) The hospital's MA share of NPR for FY 2023 is greater than 25%. The source of this information is the PA Health Care Cost Containment Council's FY 2023 Financial Analysis, Volume 1.
(5) The hospital's commercial payer ratio, defined as 100% minus the sum of the hospital's Medicare share of NPR for FY 2023 (expressed as a percent) and the hospital's MA share of NPR for FY 2023 (expressed as a percent), is less than 25%. The source of this information is the PA Health Care Cost Containment Council's FY 2023 Financial Analysis, Volume 1.
(6) The hospital does not qualify for payment under State Plan Attachment 4.19A, page 21y.
(7) The hospital does not qualify for payment under State Plan Attachment 4.19A, page 21s.
Payment Methodology
Payments will be divided proportionally among qualifying hospitals based on the percentage of each qualifying hospital's inpatient fee-for-service (FFS) PA MA days to the total inpatient FFS PA MA days of all qualifying hospitals.
Supplemental payments are subject to the regulations in 42 CFR 447.272 (relating to inpatient services: application of upper payment limits) and the application of upper payment limits for inpatient services.
Fiscal Impact
Beginning with FY 2024-2025, the Department will allocate an annualized amount of $0.400 million in total funds (Federal and State) for these supplemental payments, upon approval by the Centers for Medicare & Medicaid Services.
Public Comment
Interested persons are invited to submit written comments regarding the eligibility criteria and payment methodologies in this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120, RA-PWMAProgComments@pa.gov. The Department will review and consider comments received within 30 days in determining the qualifying criteria and 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).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1663. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2024-25 is $109,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are $108,000; (4) 2023-24 Program—$697,354,000; 2022-23 Program—$589,137,000; 2021-22 Program—$644,059,000; (7) MA—FFS; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 24-1680. Filed for public inspection November 22, 2024, 9:00 a.m.]
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