New Class of Disproportionate Share Hospital Payments [45 Pa.B. 3425]
[Saturday, June 27, 2015]The Department of Human Services (Department) is announcing its intent to create a new class of disproportionate share hospital (DSH) payments for qualifying Medical Assistance (MA) enrolled acute care general hospitals to promote access to hospital services for MA eligible persons in this Commonwealth by providing additional support for the operations of academic medical programs through the medical education of health care professionals needed to treat the MA population.
Qualifying Criteria
For a hospital to qualify for this class of DSH payment, it must meet all of the following criteria, based on its State Fiscal Year (FY) 2011-2012 MA-336 Hospital Cost Report unless otherwise specified:
(a) The hospital is enrolled in the MA Program as a general acute care hospital, and provides a comprehensive array of inpatient services (acute, psychiatric and rehabilitation) including inpatient obstetrical and neonatal services to MA eligible persons.
(b) The hospital is accredited as an adult Level I Trauma Center according to the Pennsylvania Trauma Systems Foundation 2013 annual report.
(c) The hospital ranked at least three standard deviations above the mean for the total number of inpatient days provided to MA beneficiaries.
(d) The hospital ranked above the 99th percentile of all acute care hospitals for the total number of MA discharges.
(e) The hospital is an independent academic medical center and a member of the Alliance of Independent Academic Medical Centers.
Payment Determination
The Department will pay each qualifying hospital a proportionate amount of the funding allocated to this payment based on the hospital's ratio of MA inpatient days to the total MA inpatient days for all qualifying hospitals. The hospital's ratio is multiplied by the total amount allocated for these payments to determine its payment amount. The data used for purposes of this determination will be based on the FY 2011-2012 MA-336 Hospital Cost Report.
Fiscal Impact
The FY 2014-2015 impact is $1.660 million ($0.800 million in State general funds).
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-962. (1) General Fund; (2) Implementing Year 2014-15 is $800,000; (3) 1st Succeeding Year 2015-16 through 5th Succeeding Year 2019-20 are $0; (4) 2013-14 Program—$16,831,000; 2012-13 Program— $12,618,000; 2011-12 Program—$12,618,000; (7) MA—Academic Medical Centers; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 15-1213. Filed for public inspection June 26, 2015, 9:00 a.m.]
