DEPARTMENT OF
PUBLIC WELFAREDisproportionate Share Hospital Payments [44 Pa.B. 5405]
[Saturday, August 9, 2014]The Department of Public Welfare (Department) is providing final notice of its 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 providing final notice of its change to the payment methodology for Trauma DSH payments and payments to certain Academic Medical Centers.
Background
The Department is allocating 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 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 is eliminating 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 is increasing 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 intent notice at 44 Pa.B. 134 (January 4, 2014) provided incorrect total and Federal funding allocations for the DSH payments to Critical Access and Qualifying Rural Hospitals and DSH payments for Obstetrical and Neonatal Health Care Services. The State Plan and this final notice provide the correct amounts for these FY 2013-2014 payments.
Since publication of the intent notice, the Department allocated additional State funds for the DSH payments to hospitals providing Enhanced Access to Multiple Types of Medical Care in Economically Distressed Areas. The Department published a separate intent notice and will publish a final notice addressing the total State and Federal funds allocated for this DSH payment for FY 2013-2014.
For FY 2013-2014, the Department's funding allocations 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 is not providing funding for DSH payments to qualifying hospitals that provide a high volume of MA acute care and psychiatric services and incur significant uncompensated costs.
Except for payments to certain Academic Medical Centers and Trauma DSH payments, the Department is not making any changes to the payment methodology or qualifying criteria for these DSH payments. The Department's approved State Plan provides FY 2013-2014 funding for the continuing DSH payment programs described in this notice as follows.
DSH Payments to Critical Access Hospitals and Qualifying Rural Hospitals
For FY 2013-2014, the Department is allocating $14.579 million ($6.776 million in State general funds and $7.803 million in Federal funds) for DSH payments to Critical Access and Qualifying Rural Hospitals. The Department is not changing 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 is allocating $14.374 million ($6.681 million in State general funds and $7.693 million in Federal funds) for DSH payments to Qualifying Acute Care General Hospitals for Obstetrical and Neonatal Health Care Services. The Department is not changing its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
Trauma DSH Payments
For FY 2013-2014, the Department is allocating $18.623 million ($8.656 million in State general funds and $9.967 million in Federal funds) for Trauma DSH payments.
Further, the Department changed its approved State Plan provisions addressing payment distribution. Specifically, the Department is using 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 are 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 MA and uninsured PTOS trauma visits and patient days for Level 1 and Level 2 trauma centers. This change makes the Department's State Plan consistent with 62 P. S. § 805-H(c)(5).
Except as described, the Department is not otherwise changing 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 is allocating $8.137 million ($3.782 million in State general funds and $4.355 million in Federal funds) for DSH payments to Qualified Burn Centers. The Department is not otherwise changing 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 is allocating $1.704 million $0.792 million in State general funds and $0.912 million in Federal funds) for DSH payments to qualified hospitals providing a high volume of services to MA and low-income populations. The Department is not otherwise changing 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 is allocating $24.378 million ($11.331 million in State general funds and $13.047 million in Federal funds) for payments to Academic Medical Centers.
The Department changed its approved State Plan provisions addressing payment distribution to adjust the funding allocation for each category of qualifying hospitals:
• 47.191453% of available funding is 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 is allocated to each of the other qualifying hospitals.
• Further, to ensure that payments do not exceed available funds, the Department is adjusting payments to each hospital in accordance with the approved State Plan.
Except as described, the Department is not otherwise changing 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 is allocating $4.303 million ($2.000 million in State general funds and $2.303 million in Federal funds) for DSH payments to certain MA acute care general hospitals which participate in an academic medical program. The Department is not otherwise changing its approved State Plan provisions addressing the qualifying criteria or payment methodology for these payments.
The Department published notice of its intent to allocate funding for these DSH payments at 44 Pa.B. 134. The Department received no public comments during the 30-day comment period, and will implement the changes as described in its notice of intent with the exception of the change previously described.
Fiscal Impact
The FY 2013-2014 fiscal impact, as a result of these payments, is $86.098 million ($40.018 million in State funds and $46.080 million in Federal funds).
BEVERLY D. MACKERETH,
SecretaryFiscal Note: 14-NOT-893. (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 $792,000; (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. 14-1695. Filed for public inspection August 8, 2014, 9:00 a.m.]
