disproportionate share hospital list 2019

Subsequent legislation delayed the start of these reductions, modified the reduction amounts, and extended the fiscal years subject to reductions. In previous rulemaking, we identified some potential scenarios, due to data limitations, where the DHRM finalized in 2013 could have produced some paradoxical outcomes when comparing hospital levels of uncompensated care for purposes of evaluating DSH payment targeting through the HUF. The most recent related amendments to the statute were through the Bipartisan Budget Act of 2018 (Pub. We estimate that this rulemaking is “economically significant” as measured by the $100 million threshold, and hence also a major rule under the Congressional Review Act. Regardless, the rule would incentivize states to target DSH payments to hospitals that are most in need of Medicaid DSH funding based on their serving a high volume of Medicaid inpatients and having a high level of uncompensated care. Section 1923(f)(7)(B) of the Act establishes five factors that must be considered in the development of the DHRM. Medicaid disproportionate share hospital (DSH) allotment reductions. Comment: One commenter noted that CMS proposed to estimate the targeting of section 1115 payments not excluded from reductions under the BNF for states by using DSH data from other states as a proxy, but did not provide a timeline for replacing the proxy data with actual hospital-specific data. 106314029. For psychiatric hospitals, the deadline is March 31, 2021 by 4:30 p.m. Eastern time. Found inside – Page 116... Medicare Advantage rates , and Medicare and Medicaid disproportionate share hospital ( DSH ) payments . ... The list of budgetary features embedded in the CBO score begins with the fact that the Act front - loads revenues and ... Although other sources of this information could be considered for this purpose, the statute explicitly refers to the use of data from the Census Bureau for determining the percentage of uninsured for each state. Comment: One commenter noted support for the BNF excluding diverted DSH allotment amounts, but stated that limiting this to waivers approved before July 31, 2009, unfairly limits the ability of some states to expand coverage using a model that has proven successful in the commenter's state. Response: We are finalizing a DHRM that will calculate annual reductions that will apply to unreduced DSH allotments. For example, to be used in applying the DHRM for FY 2021, all corrected and revised data would be required to be submitted to us by July 1, 2020 (and meet applicable federal requirements) to be reflected in the DHRM calculations for the DSH allotment reductions scheduled to be applied to the FY 2021 unreduced preliminary DSH allotments. 4. The ACA amended the statute by requiring aggregate reductions to state Medicaid DSH allotments annually from FY 2014 through FY 2020. We are implementing this statutory directive through the LDF. Further, we believe that the final DHRM, including the factor weighting discussed above, distributes DSH allotment reduction amounts among the states in an equitable manner, consistent with statutory requirements and does not penalize Medicaid expansion states. Subsequent legislation extended the reductions, modified the amount of the reductions, and delayed the start of the reductions until FY 2020. Therefore, we are finalizing the structure of proposed DHRM that considers five factors identified by section 1923(f)(7)(B) of the Act when determining state-specific allotment reduction amounts. (This is different than the percentage rate of uninsurance; the rate of uninsurance can be obtained by dividing 100 by this number.). of this final rule, this final rule generally finalizes the provisions as proposed in the July 2017 proposed rule. Total hospital cost is the total annual costs incurred by each hospital for furnishing inpatient hospital and outpatient hospital services. Alternatively, states could determine that the best action is to propose a methodology that would direct DSH payments reductions to hospitals that do not have high Medicaid volume and do not have high levels of uncompensated care. The commenters cited various concerns regarding the DSH audit data, including the use of out-of-date data which causes a lag between DSH policy and programmatic changes that is not reflected in audit and reporting data. We will calculate FY 2020 reductions for Massachusetts and all other states by utilizing the final DHRM. The result would be the HUF. The statute also requires that the percentage of uninsured individuals be determined on the basis of data from the Census Bureau, audited hospital cost reports, and other information likely to yield accurate data, during the most recent year for which such data are available. 1 The Senate modified this language slightly and instructed States to "take into … account the atypical costs incurred by hospitals which serve a disproportionate number of low income patients." 2 In other words, whereas the House focus was hospitals that treated a disproportionate number of Medicaid and uninsured patients, the Senate focus was more Additionally, we proposed, and are finalizing, a weight of 50 percent for the UPF to rely more heavily on more recent Census Bureau data and to align the factor weights with how these factors are set forth in statute. We believe that the final DHRM distributes DSH allotment reduction amounts among the states in an equitable manner, consistent with statutory requirements. The second factor considered in the DHRM is the UPF identified in section 1923(f)(7)(B)(i)(I) of the Act, which requires that the DHRM impose the largest percentage DSH allotment reductions on states that have the lowest percentages of uninsured individuals. Section 1923(f)(7)(A)(i) of the Act requires that the Secretary implement the aggregate reductions in federal funding for DSH payments through reductions in annual state allotments of federal funding for DSH payments (state DSH allotments), and accompanying reductions in payments to each state. Response: We considered using various alternative proportional relationships to establish the LDF. The data is reported by states as required by section 1923(j) of the Act and the “Medicaid Start Printed Page 50314Disproportionate Share Hospital Payments” final rule published on December 19, 2008 (73 FR 77904) (and herein referred to as the 2008 DSH audit final rule) requiring state reports and audits to ensure the appropriate use of Medicaid DSH payments and compliance with the hospital-specific DSH limit imposed at section 1923(g) of the Act. Comment: One commenter expressed concern that the proposed methodology will exacerbate current inequalities in Medicare IPPS and jeopardize the existence of hospitals already experiencing negative margins. Comment: One commenter stated that step 6 in the calculation should read “multiply the proportion of total unreduced allocations for the low DSH states group to total unreduced allocations for all states by the LDF percentage.”. We are finalizing use of a proxy as proposed for calculating DSH allotment reductions for purposes of the HUF and HMF. However, we are finalizing the LDF as proposed without change to our proposal to use the LDF as currently codified in § 447.594(e)(3). One commenter suggested that CMS implement a reduction cap based on each state's cost coverage percentage determined by dividing each state's total uncompensated care by its respective unreduced DSH allotment. While we appreciate the commenter's concern, considerations related to the Medicare IPPS are not included in the factors Congress has specified to be considered in the DHRM. We believe the proposed DHRM is an equitable method for calculating reduction amounts based on each state's rate of uninsurance and how well each state is targeting its DSH payments to hospitals with high volumes of Medicaid inpatients and high levels of uncompensated care. Response: We believe the DHRM as proposed will promote state targeting of payments to hospitals that qualify for DSH payments based on MIUR deeming requirements defined in section 1923(b)(1)(A) of the Act, consistent with section 1923(f)(7)(B)(i)(II)(aa) of the Act. The DHRM is determined as follows: (i) Dividing each State's preliminary unreduced DSH allotment by their respective total estimated Medicaid service expenditures for the applicable fiscal year. This amount is 75 percent of $16,583,455,656.92, which is the estimated amount of Medicare DSH payments for FY 2020 that would have been paid using the methodology prior to the Affordable Care Act. We found that these payments covered 51% of the costs of uncompensated care at hospitals receiving payments nationwide. disproportionate share hospital (DSH) payments to hospitals treating large numbers of low-income patients. Medicare provides for additional funding for so-called disproportionate share hospitals (DSH) that serve low-income . Determine each disproportionate share hospital's uncompensated care level by dividing its uncompensated care cost by total hospital cost. 10: However, for section 1115 demonstrations not approved as of July 31, 2009, any DSH allotment amounts included in budget neutrality calculations, whether for coverage expansion or otherwise, under a later approval would be subject to reduction. Some of the various alternatives included using alternative weight assignments, utilizing various alternative data sources for uncompensated cost and uninsured data, and considering alternate methods for capping individual state allotment reductions. Any hospital that exceeds the mean ratio of uncompensated care costs to total Medicaid and uninsured inpatient hospital and outpatient hospital service costs within the state is considered a hospital with a high level of uncompensated care. The goal of this book is to inform the health reform policy debateâ€"in 2009â€"with an up-to-date assessment of the research evidence. Stuart Goldstein, (410) 786-0694 and Richard Cuno, (410) 786-1111. L. 113-93), enacted April 1, 2014; Medicare Access and CHIP Reauthorization Act of 2015 (Pub. One commenter expressed concern that CMS did not provide any data indicating which states would be impacted by this proposal. Therefore, we will only be using the policy reflected in the July 2017 proposed rule and this final rule, and we will not adopt the 2013 HUF calculation as an alternative option. The proposed DHRM relies on the most recent data for all data sources with one exception. We also finalize DSH allotment amounts as soon as all necessary information is available. Response: The statute requires that larger percentage reductions be imposed on states that do not target their DSH payments on hospitals with high volumes of Medicaid inpatients and on hospitals with high levels of uncompensated care (excluding bad debt). Several commenters supported a state-specific cap on annual reductions that will allow states to keep at least a portion of their DSH allotment. These data sources include the previous year's preliminary unreduced DSH allotment, the change in the previous year's consumer price index, and state budget estimates from MBES. The preliminary and final DSH allotment amounts are also published in the Federal Register. Response: We are finalizing our proposal to apply a weight of 50 percent to the UPF to rely more heavily on the more recent Census Bureau data (as it is more recent than DSH audit data and, therefore, likely more reflective of current circumstances than DSH audit data) and to align the factor weights with how these factors are set forth in statute. is not required. Accordingly, concerns with respect to how a DHRM might have applied with respect to prior fiscal years, including FY 2018 and FY 2019, are moot. The proposed DHRM accomplishes this through the following summarized steps: 1. Response: We disagree that the reduction methodology conflicts with the statutory direction to impose “a smaller percentage reduction on low DSH States.” While the final DHRM includes the LDF to impose smaller percentage reductions on low DSH states, it is possible that the annual DSH allotment reduction percentage could be higher for one or more low DSH states than for one or more non-low DSH states based on the application of other factors identified by the statute. For purposes of the DHRM, the statute defines hospitals with high volumes of Medicaid inpatients as those defined in section 1923(b)(1)(A) of the Act. The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara Jordan Conference Center: 1330 G Street . Response: This rule does not address potential future payment and delivery reform, and does not affect state's flexibility under section 1923 of the Act to establish DSH payment methodologies. In such a case, we would cease excluding the diverted DSH amounts from reduction under the DHRM. The statute establishes parameters regarding data and data sources for specific factors in the development of the DHRM. We proposed to rely on MIUR information for use in the DHRM that CMS collects from states on an annual basis under § 447.294(d). The hospital has been designated as a disproportionate share hospital under the state Medicaid program in the period covered by this report (2019) or in either of its two previous fiscal years. The commenters noted that the need for academic medical centers to provide training, to maintain emergency standby capacity for rarely used hospital services, and to provide additional highly specialized services increases their total hospital cost compared to peer hospitals and, therefore, understates their HUF uncompensated care level compared to peer hospitals. Disproportionate share and uncompensated care payments Hospitals that treat a disproportionate share (DSH) of certain low-income patients receive additional operating and capital payments thought to offset the financial effects of these patients. should verify the contents of the documents against a final, official Urban State of Georgia Disproportionate Share Hospital (DSH) Examination Survey Part II Version 7.25 Printed 9/30/19 Property of Myers and Stauffer LC Page 1 Accordingly, we have prepared a Regulatory Impact Analysis that to the best of our ability presents the costs and benefits of the rulemaking. Response: Consistent with statutory direction, the DHRM will use uncompensated care data that excludes bad debt, including unpaid copayments and deductibles associated with individuals with a source of third party coverage for the service. Comment: Several commenters urged CMS to minimize annual DSH allotment reductions for states that have relatively low ratios of the unreduced annual DSH allotment to the number of uninsured individuals in the state. In an effort to be transparent in the application of the DSH allotment reductions, we intend to publish a separate DHRM technical guide that provides information regarding the DHRM calculation and associated data sources. This unreduced allotment is determined by calculating the allotment in section 1923(f) of the Act prior to the application of the DHRM under section 1923(f)(7) of the Act. informational resource until the Administrative Committee of the Federal Comment: Several commenters urged CMS to take into account that there is no policy reason to differentiate DSH funding for a coverage expansion demonstration in relation to the July 2009 date, and noted that the only policy reason given by CMS was that subsequent to July 31, 2009, the ACA provided states with other, non-DSH funds for such coverage expansion, thus limiting the need for diverted DSH under demos. We received a number of public comments on the proposed Factor 2—UPF. Disproportionate Share Hospital Payments The SFY 2019 DSH payments are estimated to total $81,070,360 based on the current FFY 2018 and FFY 2019 preliminary allotment amounts of $51 and $53,024,204, respectively. As such, we are finalizing reliance on existing DSH audit and reporting data in the DHRM because it represents the best available data that is consistent with existing program requirements without imposing duplicative and otherwise unnecessary burden. The following data elements would be used in the HUF calculation: The statute also requires that uncompensated care costs used in this factor of the DHRM exclude bad debt. Register, and does not replace the official print version or the official The handbook s format and style of presentation follows that of previous editions inspired by the Faye Brown approach to coding instruction. The text leads students to logical answers and provides primary supporting sources. Comment: Several commenters expressed concern regarding the use of DSH audit and reporting data for the DHRM. the current document as it appeared on Public Inspection on Effective June 2, 2017, the rule amended paragraph (c)(1) to clarify that uncompensated care costs are calculated using total cost of care for Medicaid inpatient and outpatient services, net of third-party payments. . Apply a low DSH adjustment percentage to adjust the non-low DSH and low DSH state groups' DSH funding reduction amount. In general, the DSH allotments for each state is increased by the consumer price index each year, so each state's unreduced DSH allotment remains constant in proportion to the total national DSH allotment. ANNUAL STATEMENT OF COMMUNITY BENEFITS STANDARD 2019 TEXAS NONPROFIT HOSPITALS Part I (x)€ Not-For-Profit (€)€For-Profit (received Medicaid Disproportionate Share Funds)€€ (€)€Public€€ (€)€For-Profit€€ (€)€€Yes€€(x)€€No III€HOSPITAL SYSTEMS - List all the hospitals included in this system report. As a result of our reevaluation, we subsequently proposed to modify the DHRM factor weights and to use improved data sources where possible. To help offset the costs for hospital services, these payments are given to hospitals that serve a high proportion of Medicaid and uninsured patients. In addition, we are finalizing a DHRM that would equitably allocate the statutorily-required annual reductions based on the factors specified in section 1923(f)(7) of the Act. Hospitals must meet the definition . ALL RIGHTS RESERVED. In July 28, 2017 Federal Register (82 FR 35155), we published the “Medicaid Program; State Disproportionate Share Hospital Allotment Reductions” proposed rule (herein referred to as the “the July 2017 proposed rule”), in which we proposed to establish a DHRM applicable for all fiscal years subject to allotment reduction that would account for relevant data that was unavailable to CMS during prior rulemaking for DSH allotment reductions originally set to take place for FY 2014 and FY 2015. We interpret the statute to require CMS to utilize both the UPF and the two targeting factors. This rule provides the methodology used to calculate the statutorily-required Medicaid DSH allotment reductions and does not affect the flexibility afforded to states when setting DSH state plan payment methodologies, to the extent that these methodologies are consistent with section 1923(c) of the Act and all other applicable laws and regulations. For example, a hospital that is both as a Disproportionate Share Hospital and a Sole Community Hospital may choose either type of eligibility and must abide by requirements and guidelines for that type of eligible organization/covered entity once enrolled. The DSH audit and reporting requirements apply to all hospitals receiving DSH payments under section 1923 of the Act. The following is a discussion of these comments. Response: This comment is outside the scope of this rule. For the reductions scheduled for FY 2020, we anticipate utilizing SPRY 2015 DSH audit and reporting data, which was due to CMS from states on December 31, 2018. Health (7 days ago) N Appendix A/A-0411/§482.23(c)(5) - There must be a hospital procedure for reporting transfusion reactions, adverse drug reactions, and errors in administration of drugs. On June 3, 2019, the U.S. Supreme Court issued its decision in Azar v. Allina Health Services, et al., Case No. The total of all DSH allotment reduction amounts would equal the aggregate annual reduction amount identified in statute for each applicable fiscal year. This helps ensure that states target DSH payments to high Medicaid volume hospitals and distributes the reductions in such a way as to promote the ability of all states to provide DSH funds to high Medicaid volume hospitals. Comment: One commenter expressed concern that the DHRM assigns too much weight to the UPF and suggested that the UPF calculation methodology rely on state levels of insured individuals instead of percentages of uninsured individuals. WHO WILL BENEFIT? Note: You must have either IT expertise or access to IT professionals who possess the skills to perform this work.

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