DEPARTMENT OF
HUMAN SERVICESSupplemental Payment Program Changes [46 Pa.B. 943]
[Saturday, February 20, 2016]The Department of Human Services (Department) is announcing its intent to modify eligibility criteria and payment methodologies for the Medical Assistance (MA) Dependency, MA Rehabilitation Adjustment and New Hospital Payment programs as well as increase the funding allocations for the MA Dependency and MA Rehabilitation Adjustment Payments and allocate funding for the New Hospital Payment program.
Background
During State Fiscal Year (SFY) 2010-2011, the Department established several new disproportionate share hospital (DSH) and supplemental payments for hospitals using revenues from the Quality Care Assessment Account. Among other things, the Department implemented new classes of supplemental payments including MA Dependency payments and MA Rehabilitation Adjustment payments.
Beginning in SFY 2013-2014, the Department amended its State Plan and instituted a process to collect data from new hospitals using forms designated by the Department. Beginning with a new hospital's first full State fiscal year of MA enrollment, the Department uses this data instead of the SFY 2007-2008 MA hospital cost report data to determine the hospital's eligibility for certain DSH and supplemental payments and, if eligible, the payment amounts. The payments for which a new hospital may qualify through this process include the MA Stability Payments, MA Dependency Payments, Enhanced Payments to Certain Disproportionate Share Hospitals and MA Rehabilitation Adjustment Payments.
MA Dependency Payments
The Department established MA Dependency Payments as supplemental payments for acute care general hospitals that are highly dependent upon MA Program payment and have a reduced ability to offset the costs with revenue from private insurers and other sources. The Department intends to modify the qualifying criteria used to determine a hospital's eligibility for this payment. Specifically, the Department intends to use inpatient days rather than acute care days in determining a hospital's eligibility. Under this proposed criterion, an acute care general hospital must provide at least 50,000 Fee-for-Service (FFS) and managed care days of inpatient care to Commonwealth MA beneficiaries. Further, the Department intends to use a more recent State fiscal year to determine eligibility. Specifically, the Department intends to use the MA FFS and managed care inpatient days for Commonwealth MA beneficiaries as identified in the hospital's SFY 2012-2013 MA cost report data available to the Department as of December 2015.
The Department also intends to determine a qualifying hospital's annual payment amount by multiplying the number of the hospital's Commonwealth MA FFS acute care inpatient days as identified in the State fiscal year 2012-2013 MA hospital cost report available to the Department as of December 2015 by either of the following:
• $600 for qualifying hospitals with greater than 19,000 Commonwealth MA FFS acute care inpatient days.
• $260 for other qualifying hospitals.
The Department also intends to increase the funding allocated for MA Dependency payments to $25.377 million in total funds as may be adjusted to reflect the State Plan reconciliation factor.
The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
MA Rehabilitation Adjustment Payments
The Department makes MA Rehabilitation Adjustment Payments as supplemental payments to freestanding rehabilitation hospitals enrolled in the MA Program as an inpatient rehabilitation hospital as of July 1, 2010.
The Department intends to change the percentage used in its payment methodology for these payments. Specifically, the Department intends to calculate an annual payment amount for qualifying freestanding rehabilitation hospitals equal to 147% of the total inpatient FFS MA revenue as reported in the hospital's SFY 2007-2008 MA hospital cost report available to the Department as of July 2010. The Department will continue to distribute payments to qualifying hospitals, adjusted to reflect the total amount allocated per fiscal year for this payment.
The Department also intends to increase the funding allocated for MA Rehabilitation Adjustment payments to $23.6 million in total funds as may be adjusted to reflect the State Plan reconciliation factor.
The Department does not intend to otherwise change its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
New Hospitals
To account for the proposed change to the eligibility criteria for the MA Dependency Payment, the Department intends to modify the eligibility of new hospitals for this payment. Specifically, the Department intends to eliminate a hospital's eligibility for the MA Dependency Payment as a new hospital for those hospitals for which the Department has a SFY 2012-2013 MA hospital cost report as of December 2015. The Department intends to use the eligibility criteria provisions for MA Dependency Payment for these hospitals.
For new hospitals, the Department also intends to revise the per diem amount for a qualifying new hospital's MA Dependency payment to $600 for new hospitals with more than 19,000 Commonwealth MA FFS inpatient acute care days and to $260 for other qualifying new hospitals. In addition, the Department intends to revise the percentage applied to the deflated revenue amount for a qualifying new hospital's MA Rehabilitation Adjustment payment to 147%.
The Department intends to allocate $2.729 million for new hospital payments for SFY 2015-2016.
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
For SFY 2015-2016, the Department will allocate $25.377 million ($12.178 million in State funds) for the MA Dependency supplemental payments as may be adjusted to reflect the reconciliation factor described in the State Plan.
For SFY 2015-2016, the Department will allocate $23.619 million ($11.335 million in State funds) for the MA Rehabilitation Adjustment supplemental payments as may be adjusted to reflect the reconciliation factor described in the State Plan.
For SFY 2015-2016, the Department will allocate $2.729 million ($1.310 million in State funds) for new hospitals for the MA Stability Payments, MA Dependency Payments, Enhanced Payments to Certain Disproportionate Share Hospitals and MA Rehabilitation Adjustment Payments.
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. Comments received within 30 days will be reviewed and considered in establishing the final qualifying criteria and payment methodology for this new class of DSH payments.
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).
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-993. (1) General Fund; (2) Implementing Year 2015-16 is $24,823,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$564,772,000; 2013-14 Program—$428,041,000; 2012-13 Program—$718,947,000; (7) MA—FFS; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 16-291. Filed for public inspection February 19, 2016, 9:00 a.m.]
