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PA Bulletin, Doc. No. 16-1088


High Medical Assistance Supplemental Hospital Payments

[46 Pa.B. 3347]
[Saturday, June 25, 2016]

 The Department of Human Services (Department) intends to establish an additional class of supplemental hospital payments for qualifying hospitals.

 The Department intends to make this payment, in addition to the classes of supplemental hospital payments already made under the Medical Assistance (MA) Program, to qualifying hospitals which the Department determined provide a high volume of services to MA-eligible and low-income populations in medically underserved areas. This payment is intended to promote the hospitals' continued participation in the MA Program. For a hospital to qualify for this payment, the hospital must be an acute care hospital enrolled in the Commonwealth's MA Program that meets all of the following criteria as identified in the State Fiscal Year (FY) 2012-2013 cost report available to the Department as of June 2015 unless otherwise specified:

 a) The ratio of MA days to total hospital patient days exceeds 40%.

 b) The hospital provides in excess of 40,000 inpatient days of service.

 c) The hospital has an occupancy ratio (total inpatient days used divided by total hospital bed days available) of at least 70%.

 d) The hospital is located in a census tract (United States Census 2010) designated by the Bureau of Primary Health Care of the Health Resources and Services Administration as a Medically Underserved Area.

 e) The hospital has a government dependency ratio, comprised of MA Percentage of Net Patient Revenue plus Medicare Percentage of Net Patient Revenue both as reported in the Pennsylvania Health Care Cost Containment Council's 2015 Financial Analysis, Volume One, in excess of the 95th percentile for all Commonwealth general acute care hospitals.

 The Department intends to allocate $1.5 million in State FY 2015-2016 from the State General Fund for this additional class of payments. Payments will be divided proportionately among qualifying hospitals based on the percentage of each qualifying hospital's MA inpatient days to total MA inpatient days of all qualifying facilities.

Fiscal Impact

 For FY 2015-2016, the fiscal impact as a result of this additional class of supplemental hospital payments will be $3.111 million in total funds ($1.500 million in State General funds and $1.611 million in Federal funds).

Public Comment

 Interested persons are invited to submit written comments to this notice within 30 days of publication to the Department of Human Services, Office of Medical Assistance Programs c/o Deputy's Secretary Office, Attn: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Persons with a disability may use the Pennsylvania AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-1039. (1) General Fund; (2) Implementing Year 2015-16 is $1,500,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$9,071,000; 2013-14 Program—$9,071,000; 2012-13 Program—$7,937,000; (7) MA—Physician Practice Plans; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 16-1088. Filed for public inspection June 24, 2016, 9:00 a.m.]

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