DEPARTMENT OF
PUBLIC WELFAREEmergency Department and Outpatient Access Payments Purpose of Notice
[38 Pa.B. 7123]
[Saturday, December 27, 2008]The purpose of this notice is to announce that the Department of Public Welfare (Department) intends to amend the Commonwealth's Title XIX State Plan to authorize additional outpatient payments to certain acute care general hospitals that will be funded with revenues generated through a hospital assessment imposed by the City of Philadelphia.
Background
On July 4, 2008, the Pennsylvania General Assembly enacted Article IV-E of the Public Welfare Code (62 P. S. §§ 801-E--808-E) to authorize the City of Philadelphia to impose, by ordinance, a monetary assessment on the non-Medicare net operating revenue of acute care general hospitals located in the city. The new Hospital Assessment Program (Program) is intended to generate additional revenues to fund Medical Assistance (MA) expenditures for hospital emergency department services in Philadelphia. The Program is also expected to generate additional funding to support the city's public health clinics. To ensure receipt of Federal matching funds for the MA payments made with these assessment revenues, the Department must submit a waiver request to the Federal Centers for Medicare and Medicaid Services (CMS). Once that waiver is approved, the city may impose the assessment as specified in Article IV-E effective January 1, 2009 through June 30, 2013.
In authorizing the Program, the General Assembly recognized that a greater proportion of Philadelphia's population receives MA benefits than any other county in this Commonwealth and that the demand for emergency department services in the city hospitals often exceeds the capacity of the area's emergency department's system. By establishing a mechanism to generate additional revenues through hospital assessments, the General Assembly sought to assure that MA recipients would continue to have access to critical hospital services and that all citizens would have access to emergency department services within the city. Under Article IV-E, funds generated from the Program must be deposited in a restricted account and used by the Department to make ''supplemental or increased medical assistance payments for emergency department services to general acute care hospitals . . . and to maintain or increase other medical assistance payments to hospitals within [Philadelphia], as specified in the Commonwealth's approved Title XIX State Plan.'' 62 P. S. § 804-E.
Consistent with Article IV-E, the Department intends to submit a State Plan Amendment (SPA) to CMS to authorize the emergency department and outpatient access payments to acute care general hospitals in Philadelphia with emergency departments that provide at least 1,000 emergency department services to Pennsylvania MA patients per year. Under the SPA, the Department will distribute the additional payments to qualifying acute care general hospitals based on each qualifying hospital's historical outpatient MA claims. Payments to a qualifying hospital under the State Plan will be limited to the amount permitted by the hospital's OBRA 93 hospital specific limit. The Department is also considering including other limits on the payments in the SPA, such as limiting the maximum payment amount to 3% of the hospital's net patient revenue. Hospitals that furnish acute care inpatient services to patients who are predominantly under the age of 18 or hospitals that receive a disproportionate share payment for enhanced access to multiple types of medical care in economically distressed areas of this Commonwealth under the State Plan will not be eligible to receive these additional payments.
These payments are contingent upon CMS' approval of the SPA and the waiver authorizing implementation of Philadelphia hospital assessment in accordance with the Article IV-E.
Fiscal Impact
For Fiscal Year (FY) 2008-2009, the fiscal impact as a result of making these outpatient payments is $68.400 million in total funds ($31.108 million in State general funds and $37.292 million in Federal funds). For Fiscal Year 2009-2010, the fiscal impact as a result of making these outpatient payments is $136.800 million in total funds ($61.919 million in State general funds and $74.881 million in Federal funds).
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 potential revisions to the proposed payment methods and standards described in 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) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-577. (1) General Fund; (2) Implementing Year 2008-09 is $31.108M; (3) 1st Succeeding Year 2009-10 is $61.919M; 2nd Succeeding Year 2010-11 is $61.919M; 3rd Succeeding Year 2011-12 is $61.919M; 4th Succeeding Year 2012-13 is $61.919M; 5th Succeeding Year 2013-14 is $61.919M; (4) 2007-08 Program $593.992M; 2006-07 Program $671.472M; 2005-06 Program $945.950M; (7) Medical Assistance--Outpatient; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 08-2354. Filed for public inspection December 26, 2008, 9:00 a.m.]
