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PA Bulletin, Doc. No. 21-1540



Disproportionate Share Payments to Qualifying Hospitals

[51 Pa.B. 5913]
[Saturday, September 11, 2021]

 The Department of Human Services (Department) is announcing its intent to allocate funds for a class of disproportionate share hospital (DSH) payments for qualifying acute care general hospitals in Fiscal Year (FY) 2021-2022. These payments will provide financial relief to hospitals and promote access to acute care services for Pennsylvania Medical Assistance (MA) beneficiaries during the novel coronavirus (COVID-19) pandemic. The Department is updating the payment methodology for these hospitals, but the Department is not otherwise changing the eligibility criteria for these payments.

Payment Methodology

 The Department will determine a qualifying hospital's annual payment amount by multiplying the hospital's number of Pennsylvania MA inpatient acute care days, both fee-for-service and managed care, by either:

 a) $84.77 for qualifying hospitals with at least 90% MA dependence percent ranking; or,

 b) $67.82 for qualifying hospitals with at least 75% but less than 90% MA dependence percent ranking; or,

 c) $50.86 for qualifying hospitals with at least 50% but less than 75% MA dependence percent ranking; or,

 d) $33.91 for qualifying hospitals with less than 50% MA dependence percent ranking.

 For purposes of these DSH payments, the Department determines each hospital's MA dependence statistic by dividing the hospital's Pennsylvania MA inpatient acute care days, both fee-for-service and managed care, by the hospital's total hospital inpatient acute care days. The Department determines each hospital's MA dependence percent ranking using the hospital's MA dependence statistic in relation to all eligible hospitals. The source of the information is the FY 2017-2018 MA-336 Hospital Cost Report, as available to the Department on April 7, 2020.

 All payment limitations are still applicable, including those limitations that the Commonwealth may not exceed its aggregate annual DSH allotment and that no hospital may receive DSH payments in excess of its hospital-specific limit. The Department will not redistribute DSH payments made under this class of DSH payments to qualifying hospitals as a result of a qualifying hospital exceeding its hospital-specific DSH limit.

Fiscal Impact

 For FY 2021-2022, the Department will allocate an annualized amount of $85.586 million in total funds (State and Federal) for these DSH payments, upon approval by the Centers for Medicare & Medicaid Services and adjusted to reflect the reconciliation factor described in Part VI of the Pennsylvania State Plan.

Public Comment

 Interested persons are invited to submit written comments regarding this proposed payment 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-1463. (1) General Fund; (2) Implementing Year 2021-22 is $35,193,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $0; (4) 2020-21 Program—$808,350,000; 2019-20 Program—$344,107,000; 2018-19 Program—$342,544,000; (7) MA—Fee-for-Service; (8) recommends adoption. The MA—Fee-for-Service appropriation is able to absorb this increase.

[Pa.B. Doc. No. 21-1540. Filed for public inspection September 10, 2021, 9:00 a.m.]

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