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PA Bulletin, Doc. No. 14-1364



New Class of Disproportionate Share Hospital Payments

[44 Pa.B. 4044]
[Saturday, June 28, 2014]

 The Department of Public Welfare (Department) is announcing its intent to create a new class of disproportionate share hospital (DSH) payments for those acute care general hospitals that provide a significant amount of services to the indigent and Medical Assistance (MA) populations residing in Pennsylvania (PA) cities with a per capita income substantially below the Statewide average. These payments provide additional financial support to hospitals providing inpatient hospital services and serve an inordinate amount of MA beneficiaries in impoverished areas of this Commonwealth.

Qualifying Criteria

 For a hospital to qualify for this class of DSH payment, it must meet all of the following proposed criteria, based on its Fiscal Year (FY) 2011-2012 PA MA hospital cost report unless otherwise specified:

 (a) The hospital is enrolled in PA MA as an acute care general hospital.

 (b) The hospital provides at least 20,000 inpatient days of care to MA beneficiaries.

 (c) The hospital has an MA inpatient utilization rate of at least 25% as determined by dividing the hospital's MA days by its total days of inpatient care.

 (d) The hospital has a negative 3-year average change in net patient revenue according to the Health Care Cost Containment Council's Fiscal Year 2012 Financial Analysis, Volume One, General Acute Care Hospitals.

 (e) The hospital is located in a county in this Commonwealth which contains a city with a population of 30,000 or more and that city has a per capita income below 60% of the average per capita income for the Commonwealth as documented in the 2010 United States census data.

Payment Determination

 The Department intends to pay each qualifying hospital a proportionate amount of the funding allocated to this payment based on the hospital's ratio of MA inpatient days to the total MA inpatient days for all qualifying hospitals. The hospital's ratio is multiplied by the total amount allocated for these payments to determine its payment amount. The data used for purposes of this determination will be based on the FY 2011-2012 PA MA hospital cost report.

Fiscal Impact

 The FY 2013-2014 impact is $4.128 million ($1.989 million in State general funds).

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 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).


Fiscal Note: 14-NOT-891. (1) General Fund; (2) Implementing Year 2013-14 is $1,989,000; (3) 1st Succeeding Year 2014-15 through 5th Succeeding Year 2018-19 are $0; (4) 2012-13 Program—$268,112,000; 2011-12 Program—$325,685,000; 2010-11 Program—$243,809,000; (7) MA—Inpatient; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 14-1364. Filed for public inspection June 27, 2014, 9:00 a.m.]

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