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PA Bulletin, Doc. No. 14-2161



Additional Class of Disproportionate Share Payment

[44 Pa.B. 6720]
[Saturday, October 18, 2014]

 The Department of Public Welfare (Department) is providing final notice of its establishment of a new class of disproportionate share hospital (DSH) payments to certain qualifying hospitals that provide a high volume of services to the Medical Assistance (MA) population to ensure their participation in the MA Program. This payment promotes additional access to inpatient and ancillary outpatient services and supports academic medical programs that provide integrated patient centered medical services. The Department is allocating funding for this additional class of DSH payment to qualifying hospitals for Fiscal Year (FY) 2013-2014.

 The Department determines a hospital eligible for this additional class of DSH payment if the hospital meets all of the criteria listed as follows. Unless otherwise stated, the source of the information is the State FY 2010-2011 MA cost report (MA-336).

 1. The hospital is enrolled in the Pennsylvania (PA) MA Program as a general acute care hospital.

 2. The hospital ranked at or above the 92nd percentile of all acute care hospitals on the total acute care inpatient days provided to MA beneficiaries.

 3. The hospital ranked at or above the 94th percentile of all acute care hospitals on Net PA MA Outpatient Revenues.

 4. The hospital is accredited as an Adult Level I Trauma Center and a Pediatric Level I Trauma Center according to the Pennsylvania Trauma Systems Foundation's 2012 Annual Report.

 5. The hospital is part of an academic medical center that includes a regional medical campus in a county of the fourth class.

 The Department is dividing the total payment proportionately among all qualifying hospitals based on each hospital's total MA acute care inpatient days to total MA acute care inpatient days for all qualified hospitals. In making these payments, the Department ensures that no hospital will receive any DSH payment that is in excess of its hospital-specific DSH upper limit and the Commonwealth will not exceed its aggregate DSH allotment.

 The Department published notice of its intent to allocate funding for these DSH payments at 44 Pa.B. 2341 (April 12, 2014). The Department received one public comment during the 30-day comment period. The commentator stated that the criteria established for this additional class of DSH payments would qualify only a small number of hospitals. The commentator also suggested improved access to care would be better served by using all available funding, including these funds, to update the Outpatient Fee Schedule.

 The Department recognizes that the qualifying criteria encompasses a select group of hospitals but also identifies that these hospitals provide a high volume of services to the MA population. As acknowledged by the commentator, the criteria recognize the importance of providing funding to teaching hospitals in this Commonwealth. Further, the establishment of this DSH payment does not preclude the Department from increasing existing payments or establishing new ones as determined to be necessary or desirable. Accordingly, the Department is implementing the funding for this additional class of DSH payment, as described in its notice of intent, to promote additional access to inpatient and ancillary outpatient services and to support academic medical programs for integrated patient centered medical services.

Fiscal Impact

 The FY 2013-2014 impact, as a result of the funding allocation for these payments is $5.379 million ($2.5 million in State general funds and $2.879 million in Federal funds upon approval by the Centers for Medicare and Medicaid Services).


Fiscal Note: 14-NOT-911. (1) General Fund; (2) Implementing Year 2013-14 is $2,500,000; (3) 1st Succeeding Year 2014-15 through 5th Succeeding Year 2018-19 are $0; (4) 2012-13 Program—$12,618,000; 2011-12 Program—$12,618,000; 2010-11 Program—$18,871,000; (7) MA—Academic Medical Centers; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 14-2161. Filed for public inspection October 17, 2014, 9:00 a.m.]

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