1695 Disproportionate share payments for enhanced access to emergency department services and emergency department and outpatient access supplemental payments
DEPARTMENT OF
HUMAN SERVICESDisproportionate Share Payments for Enhanced Access to Emergency Department Services and Emergency Department and Outpatient Access Supplemental Payments [45 Pa.B. 5738]
[Saturday, September 19, 2015]The Department of Human Services (Department) is providing final notice of its establishment of new class of disproportionate share hospital (DSH) payments for certain acute care general hospitals funded with revenues generated through the hospital assessment imposed by the City of Philadelphia (City).
Background
On July 4, 2008, the General Assembly enacted Article VIII-E of the Public Welfare Code (62 P. S. §§ 801-E—808-E) to authorize the City to impose, by ordinance, a monetary assessment on the non-Medicare net operating revenue of acute care general hospitals located in the City for purposes of assuring access to hospital and emergency department services. The City passed an ordinance implementing a Hospital Assessment Program (Program) effective January 1, 2009, and the Program has been in place since that time. The Program generates additional revenues to fund Medical Assistance (MA) expenditures for hospital emergency department and other hospital services in Philadelphia. The Program also generates additional funding to support the City's public health clinics. The MA funding from the Program is currently being used to fund emergency department and outpatient access supplemental payments as approved by the Centers for Medicare and Medicaid Services (CMS).
This new class of DSH payments is also funded through the Program and is intended to help offset the costs incurred by acute care general hospitals in the City that provide a significant amount of emergency services to MA beneficiaries. Many emergency department patients are subsequently admitted to the hospital. To promote access to these critical hospital and emergency services, the Department is allocating a portion of the funding from the existing emergency department and outpatient access supplemental payment to this new class of DSH payments.
The Department's notice of its intent to implement this new class of DSH payments was published at 44 Pa.B. 7967 (December 20, 2014). The Department received no public comments during the comment period and has implemented the changes as described in its notice of intent. On May 27, 2015, CMS approved the Department's State Plan Amendment to implement this new class of DSH payments for acute care general hospitals located in the City with emergency departments that provide at least 1,000 emergency department visits to Pennsylvania MA patients per year. Hospitals that furnish acute care inpatient services to patients who are predominantly under 18 years of age or hospitals that receive a DSH payment for enhanced access to multiple types of medical care in economically distressed areas of this Commonwealth under the State Plan are not eligible to receive this additional payment. The Department distributes the additional payments to qualifying acute care general hospitals based on each qualifying hospital's historical MA inpatient Title XIX fee-for-service revenue using Fiscal Year 2011-2012 MA cost report data. Payments to a qualifying hospital under the State Plan are limited to the amount permitted by the hospital's hospital-specific limit. The maximum payment is limited to 2.91% of the hospital's net patient revenue.
Since qualification for the new DSH payment is also related to MA beneficiaries seen in hospital emergency departments, a hospital eligible to receive the new DSH payment is not eligible to receive an emergency department and outpatient access supplemental payment. For this reason, the Department modified the criteria to qualify for the emergency department and outpatient access supplemental payment to reflect this change and modified the amount of funds allocated for this payment. All other qualifying criteria and the payment methodology for the current emergency department and outpatient access supplemental payment remain unchanged.
Fiscal Impact
The Department saw no increase in costs to the MA Program as a result of these payments.
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-974. (1) General Fund;
(7) MA—Outpatient; (2) Implementing Year 2015-16 is -$76,840,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$351,391,000; 2013-14 Program—$264,179,000; 2012-13 Program—$450,835,000;
(7) MA—Inpatient; (2) Implementing Year 2015-16 is $76,840,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $0; (4) 2014-15 Program—$213,381,000; 2013-14 Program—$163,862,000; 2012-13 Program—$268,112,000;
(8) recommends adoption. Funds have been included in the budget to cover this cost.
This action will result in a shift of costs from the MA—Outpatient appropriation to the MA—Inpatient appropriation.
[Pa.B. Doc. No. 15-1695. Filed for public inspection September 18, 2015, 9:00 a.m.]
