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PA Bulletin, Doc. No. 21-813



Supplemental Payments to Qualifying Hospitals

[51 Pa.B. 2886]
[Saturday, May 22, 2021]

 The Department of Human Services (Department) is announcing its intent to allocate annualized funds for fiscal year (FY) 2020-2021 supplemental payments to qualifying acute care general hospitals that treat a high volume of opioid use disorder (OUD) patients in their emergency rooms.

Qualifying Criteria

 A hospital is eligible for these supplemental payments if the hospital meets the following criteria. Unless otherwise stated, the source of the information is the FY 2016-2017 MA-336 Hospital Cost Report available to the Department as of October 29, 2019.

 a) The hospital is enrolled in the Pennsylvania Medical Assistance (MA) Program as an acute care general hospital, licensed by the Department of Health;

 b) The hospital provided at least 150,000 total inpatient acute care days;

 c) The hospital provided greater than 60,000 inpatient acute care days of care, both fee-for-service (FFS) and managed care combined, to MA beneficiaries; and,

 d) The hospital treated at least 1,000 OUD patients in the emergency room in calendar year 2019, as determined for purposes of the OUD Quality Improvement Program, using encounter data compiled by the Department for the FY 2019-2020 OUD Quality Improvement Program as of December 10, 2020.

 Payments will be divided proportionately among qualified hospitals based on each hospital's FFS Pennsylvania MA inpatient acute care days to total FFS Pennsylvania MA inpatient acute care days for all qualifying hospitals.

Fiscal Impact

 For FY 2020-2021, the Department will allocate $45.988 million in total funds for these supplemental payments, 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 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 Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

Acting Secretary

Fiscal Note: 14-NOT-1432. (1) General Fund; (2) Im- plementing Year 2020-21 is $0; (3) 1st Succeeding Year 2021-22 is $10,375,000; 2nd Succeeding Year 2022-23 through 5th Succeeding Year 2025-26 are $0; (4) 2019-20 Program—$344,107,000; 2018-19 Program—$342,544,000; 2017-18 Program—$477,690,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 21-813. Filed for public inspection May 21, 2021, 9:00 a.m.]

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