DEPARTMENT OF
PUBLIC WELFAREDisproportionate Share Hospital Payments [44 Pa.B. 134]
[Saturday, January 4, 2014]The Department of Public Welfare (Department) is announcing its intended funding allocations for several classes of disproportionate share hospital (DSH) payments made to qualifying Medical Assistance (MA) enrolled acute care general hospitals. Further, the Department is announcing its intent to change the payment methodology for Trauma DSH payments and payments to certain Academic Medical Centers.
Background
The Department intends to allocate funding for certain classes of DSH payments to qualifying acute care general hospitals for Fiscal Year (FY) 2013-2014. Specifically, these classes of payments include DSH payments to Critical Access and Qualifying Rural Hospitals, DSH payments for Obstetrical and Neonatal Health Care services, Trauma DSH payments, DSH payments to certain Burn Centers, DSH payments to hospitals providing Enhanced Access to Multiple Types of Medical Care in Economically Distressed Areas, DSH payments to hospitals providing a high volume of services to MA and low-income populations, DSH payments to certain Academic Medical Centers and DSH payments to certain MA acute care general hospitals which participate in an academic medical program. Additionally, the Department intends to eliminate funding for DSH payments to hospitals that provide a high volume of MA acute care and psychiatric services and incur significant uncompensated care costs.
The Department intends to increase the funding allocations from FY 2012-2013 funding levels for DSH payments to Critical Access and Qualifying Rural Hospitals, DSH payments for Obstetrical and Neonatal Health Care Services, and DSH payments to certain Academic Medical Centers for FY 2013-2014. The Department intends to decrease the funding allocation from the FY 2012-2013 funding level for DSH Payments to Hospitals that Provide Enhanced Access to Multiple Types of Medical Care in Economically Distressed Areas for FY 2013-2014. For FY 2013-2014, the Department's intended funding allocations will remain at the same levels as for FY 2012-2013 for Trauma DSH payments, DSH payments to certain Burn Centers, DSH payments to hospitals providing a high volume of services to MA and low-income populations and DSH payments to certain MA acute care general hospitals that participate in an academic medical program. For FY 2013-2014, the Department does not intend to provide funding for DSH payments to certain qualifying hospitals that provide a high volume of MA acute care and psychiatric services and incur significant uncompensated costs. The Department's approved State Plan does not provide funding for these various classes of DSH payments after FY 2012-2013. To continue these DSH payments in FY 2013-2014, the Department has determined its intended funding levels for these various payments.
Except for payments to certain Academic Medical Centers and Trauma DSH payments, the Department is not planning any additional changes to the payment methodology or qualifying criteria for these DSH payments.
DSH Payments to Critical Access Hospitals and Qualifying Rural Hospitals
For FY 2013-2014, the Department intends to allocate $14.894 million ($6.776 million in State funds and $8.118 million in Federal funds upon approval by the Centers for Medicare and Medicaid Services (CMS)) for DSH payments to Critical Access and Qualifying Rural Hospitals. The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
DSH Payments to Qualifying Acute Care General Hospitals for Obstetrical and Neonatal Health Care Services
For FY 2013-2014, the Department intends to allocate $14.433 million ($6.681 million in State funds and $7.752 million in Federal funds upon approval by the CMS) for DSH payments to Qualifying Hospitals providing obstetrical and neonatal health care services. The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
Trauma DSH Payments
For FY 2013-2014, the Department intends to allocate $18.623 million ($8.656 million in State general funds and $9.967 million in Federal funds upon approval by the CMS) for Trauma DSH payments.
Further, the Department intends to change its approved State Plan provisions addressing payment distribution. Specifically, the Department plans to use funds unspent from payments to qualifying hospitals accredited or seeking accreditation as Level 3 trauma centers to make payments to qualifying hospitals accredited as Level 1 and Level 2 trauma centers as follows: 50% of unspent Level 3 funds shall be distributed equally among qualified Level 1 and 2 trauma centers; 50% of unspent Level 3 funds shall be distributed on the basis of each qualified Level 1 and Level 2 trauma center's percentage of medical assistance and uninsured Pennsylvania Trauma Outcomes Study (PTOS) trauma visits and patient days compared to the Pennsylvania Statewide total number of medical assistance and uninsured PTOS trauma visits and patient days for Level 1 and Level 2 trauma centers. This intended change will make the Department's State Plan consistent with the Public Welfare Code requirements at 62 P. S. § 805-H(c)(5).
Except as described, the Department does not intend to otherwise change the qualifying criteria or payment methodology for these payments.
DSH Payments to Qualified Acute Care General Hospital Burn Centers
For FY 2013-2014, the Department intends to allocate $8.137 million ($3.782 million in State general funds and $4.355 million in Federal funds upon approval by the CMS) for this DSH payment to Qualified Burn Centers. The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
DSH Payments to Qualifying Acute Care General Hospitals that Provide Enhanced Access to Multiple Types of Medical Care in Economically Distressed Areas of the Commonwealth
For FY 2013-2014, the Department intends to allocate $15.731 million ($7.312 million in State general funds and $8.419 million in Federal funds upon approval by the CMS) for this DSH payment to qualified hospitals providing enhanced access to multiple types of medical care in economically distressed areas. The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
DSH Payments to Qualifying Acute Care General Hospitals that Provide a High Volume of Services to MA Eligible and Low-Income Populations
For FY 2013-2014, the Department intends to allocate $1.704 million ($0.792 million in State general funds and $0.912 million in Federal funds upon approval by the CMS) for this DSH payment to qualified hospitals providing a high volume of services to MA and low-income populations. The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
Payments to Certain Academic Medical Centers
For FY 2013-2014, the Department intends to allocate $24.378 million ($11.331 million in State general funds and $13.047 million in Federal funds upon approval by the CMS) for payments to Academic Medical Centers.
The Department intends to change its approved State Plan provisions addressing payment distribution to qualifying hospitals as follows to compensate qualifying large hospitals more in proportion to their size compared with other qualifying hospitals:
• 47.191453% of available funding will be allocated to a large hospital, defined as having at least 750 set up and staffed beds based on the hospital's FY 2002-2003 Medical Assistance Cost Report.
• 26.4042735% of available funding will be allocated to each of the other qualifying hospitals.
• Further, to ensure that payments do not exceed available funds, the Department plans to adjust payments to each hospital in accordance with the approved State Plan.
Except as described, the Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
DSH Payments for Certain MA Acute Care General Hospitals which Participate in an Academic Medical Program
For FY 2013-2014, the Department intends to allocate $4.303 million ($2.000 million in State general funds and $2.303 million in Federal funds upon approval by the CMS) for this payment to certain MA acute care general hospitals which participate in an academic medical program. The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
Fiscal Impact
The FY 2013-2014 fiscal impact, as a result of these payments is $102.203 million ($47.330 million in State funds and $54.873 million in Federal funds upon approval by the CMS).
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 to this notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5988 (voice users).
BEVERLY D. MACKERETH,
SecretaryFiscal Note: 14-NOT-854. (1) General Fund;
(7) MA—Critical Access Hospitals; (2) Implementing Year 2013-14 is $6,776,000; (3) 1st Succeeding Year 2014-15 through 5th Succeeding Year 2018-19 are $0; (4) 2012-13 Program—$4,076,000; 2011-12 $3,218,000; 2010-11 Program—$4,677,000;
(7) MA—Obstetric and Neonatal Services; (2) Implementing Year 2013-14 is $6,681,000; (3) 1st Succeeding Year 2014-15 through 5th Succeeding Year 2018-19 are $0; (4) 2012-13 Program—$3,681,000; 2011-12 Program—$3,313,000; 2010-11 Program—$4,815,000;
(7) Trauma Centers; (2) Implementing Year 2013-14 is $8,656,000; (3) 1st Succeeding Year 2014-15 through 5th Succeeding Year 2018-19 are $0; (4) 2012-13 Program—$8,656,000; 2011-12 Program—$7,790,000; 2010-11 Program—$11,322,000;
(7) Hospital Based Burn Centers; (2) Implementing Year 2013-14 is $3,782,000; (3) 1st Succeeding Year 2014-15 through 5th Succeeding Year 2018-19 are $0; (4) 2012-13 Program—$3,782,000; 2011-12 Program—$3,404,000; 2010-11 Program—$4,946,000;
(7) MA—Academic Medical Centers; (2) Implementing Year 2013-14 is $13,331,000; (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—Inpatient; (2) Implementing Year 2013-14 is $8,104,000; (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;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 14-52. Filed for public inspection January 3, 2014, 9:00 a.m.]
