=======

art.015/4/015/3/015/2/015/1

=======

1-1

ARTICLE 15

1-2

RELATING TO HOSPITAL UNCOMPENSATED CARE

1-3

     SECTION 1. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter 40-8.3

1-4

entitled “Uncompensated Care” are hereby amended to read as follows:

1-5

     40-8.3-2. Definitions. -- As used in this chapter:

1-6

     (1) "Base year" means for the purpose of calculating a disproportionate share payment for

1-7

any fiscal year ending after September 30, 2010 2011, the period from October 1, 2008 2009

1-8

through September 30, 2009 2010, and for any fiscal year ending after September 30, 2011 2012,

1-9

the period from October 1, 2009 2010 through September 30, 2010 2011.

1-10

     (2) "Medical assistance inpatient utilization rate for a hospital" means a fraction

1-11

(expressed as a percentage) the numerator of which is the hospital's number of inpatient days

1-12

during the base year attributable to patients who were eligible for medical assistance during the

1-13

base year and the denominator of which is the total number of the hospital's inpatient days in the

1-14

base year.

1-15

      (3) "Participating hospital" means any nongovernment and nonpsychiatric hospital that:

1-16

(i) was licensed as a hospital in accordance with chapter 17 of title 23 during the base year; (ii)

1-17

achieved a medical assistance inpatient utilization rate of at least one percent (1%) during the

1-18

base year; and (iii) continues to be licensed as a hospital in accordance with chapter 17 of title 23

1-19

during the payment year.

1-20

     (4) "Uncompensated care costs" means, as to any hospital, the sum of: (i) the cost

1-21

incurred by such hospital during the base year for inpatient or outpatient services attributable to

1-22

charity care (free care and bad debts) for which the patient has no health insurance or other third-

1-23

party coverage less payments, if any, received directly from such patients; and (ii) the cost

1-24

incurred by such hospital during the base year for inpatient or out-patient services attributable to

1-25

Medicaid beneficiaries less any Medicaid reimbursement received therefor; multiplied by the

1-26

uncompensated care index.

1-27

     (5) "Uncompensated care index" means the annual percentage increase for hospitals

1-28

established pursuant to § 27-19-14 for each year after the base year, up to and including the

1-29

payment year, provided, however, that the uncompensated care index for the payment year ending

1-30

September 30, 2007 shall be deemed to be five and thirty-eight hundredths percent (5.38%), and

1-31

that the uncompensated care index for the payment year ending September 30, 2008 shall be

2-1

deemed to be five and forty-seven hundredths percent (5.47%), and that the uncompensated care

2-2

index for the payment year ending September 30, 2009 shall be deemed to be five and thirty-eight

2-3

hundredths percent (5.38%), and that the uncompensated care index for the payment years ending

2-4

September 30, 2010, September 30, 2011, and September 30, 2012 and September 30, 2013 shall

2-5

be deemed to be five and thirty hundredths percent (5.30%).

2-6

     40-8.3-3. Implementation. -- (a) For the fiscal year commencing on October 1, 2009 and

2-7

ending September 30, 2010, the department of human services shall submit to the Secretary of the

2-8

U.S. Department of Health and Human Services a state plan amendment to the Rhode Island

2-9

Medicaid state plan for disproportionate share hospital payments (DSH Plan) to provide:

2-10

     (1) That the disproportionate share hospital payments to all participating hospitals not to

2-11

exceed an aggregate limit of $117.8 million, to be allocated by the department to the Pool A, Pool

2-12

C and Pool D components of the DSH Plan;

2-13

     (2) That the Pool D allotment shall be distributed among the participating hospitals in

2-14

direct proportion to the individual participating hospital's uncompensated care costs for the base

2-15

year, inflated by the uncompensated care index to the total uncompensated care costs for the base

2-16

year inflated by uncompensated care index for all participating hospitals. The disproportionate

2-17

share payments shall be made on or before July 12, 2010 and are expressly conditioned upon

2-18

approval on or before July 5, 2010 by the Secretary of the U.S. Department of Health and Human

2-19

Services, or his or her authorized representative, of all Medicaid state plan amendments necessary

2-20

to secure for the state the benefit of federal financial participation in federal fiscal year 2010 for

2-21

the disproportionate share payments.

2-22

     (b)(a) For the fiscal year commencing on October 1, 2010 and ending September 30,

2-23

2011, the department of human services shall submit to the Secretary of the U.S. Department of

2-24

Health and Human Services a state plan amendment to the Rhode Island Medicaid state plan for

2-25

disproportionate share hospital payments (DSH Plan) to provide:

2-26

     (1) That the disproportionate share hospital payments to all participating hospitals not to

2-27

exceed an aggregate limit of $125.4 million, to be allocated by the department to the Pool A, Pool

2-28

C and Pool D components of the DSH Plan;

2-29

     (2) That the Pool D allotment shall be distributed among the participating hospitals in

2-30

direct proportion to the individual participating hospital's uncompensated care costs for the base

2-31

year, inflated by the uncompensated care index to the total uncompensated care costs for the base

2-32

year inflated by uncompensated care index for all participating hospitals. The disproportionate

2-33

share payments shall be made on or before July 18, 2011 and are expressly conditioned upon

2-34

approval on or before July 11, 2011 by the Secretary of the U.S. Department of Health and

3-1

Human Services, or his or her authorized representative, of all Medicaid state plan amendments

3-2

necessary to secure for the state the benefit of federal financial participation in federal fiscal year

3-3

2011 for the disproportionate share payments.

3-4

     (c)(b) For the fiscal year commencing on October 1, 2011 and ending September 30,

3-5

2012, the executive office of health and human services shall submit to the Secretary of the U.S.

3-6

Department of Health and Human Services a state plan amendment to the Rhode Island Medicaid

3-7

state plan for disproportionate share hospital payments (DSH Plan) to provide:

3-8

     (1) That the disproportionate share hospital payments to all participating hospitals, not to

3-9

exceed an aggregate limit of $129.8 $126.2 million, shall be allocated by the executive office of

3-10

health and human services to the Pool A, Pool C and Pool D components of the DSH Plan; and,

3-11

     (2) That the Pool D allotment shall be distributed among the participating hospitals in

3-12

direct proportion to the individual participating hospital's uncompensated care costs for the base

3-13

year, inflated by the uncompensated care index to the total uncompensated care costs for the base

3-14

year inflated by uncompensated care index for all participating hospitals. The disproportionate

3-15

share payments shall be made on or before July 16, 2012 and are expressly conditioned upon

3-16

approval on or before July 9, 2012 by the Secretary of the U.S. Department of Health and Human

3-17

Services, or his or her authorized representative, of all Medicaid state plan amendments necessary

3-18

to secure for the state the benefit of federal financial participation in federal fiscal year 2012 for

3-19

the disproportionate share payments.

3-20

     (c) For federal fiscal year 2013, commencing on October 1, 2012 and ending September

3-21

30, 2013, the executive office of health and human services shall submit to the Secretary of the

3-22

U.S. Department of Health and Human Services a state plan amendment to the Rhode Island

3-23

Medicaid state plan for disproportionate share hospital payments (DSH Plan) to provide:

3-24

     (1) That the disproportionate share hospital payments to all participating hospitals, not to

3-25

exceed an aggregate limit of $128.3 million, shall be allocated by the executive office of health

3-26

and human services to the Pool A, Pool C and Pool D components of the DSH Plan; and,

3-27

     (2) That the Pool D allotment shall be distributed among the participating hospitals in

3-28

direct proportion to the individual participating hospital's uncompensated care costs for the base

3-29

year, inflated by the uncompensated care index to the total uncompensated care costs for the base

3-30

year inflated by uncompensated care index for all participating hospitals. The disproportionate

3-31

share payments shall be made on or before July 15, 2013 and are expressly conditioned upon

3-32

approval on or before July 8, 2013 by the Secretary of the U.S. Department of Health and Human

3-33

Services, or his or her authorized representative, of all Medicaid state plan amendments necessary

3-34

to secure for the state the benefit of federal financial participation in federal fiscal year 2013 for

4-1

the disproportionate share payments.

4-2

     (d) No provision is made pursuant to this chapter for disproportionate share hospital

4-3

payments to participating hospitals for uncompensated care costs related to graduate medical

4-4

education programs.

4-5

     SECTION 2. Chapter 40-8.3 of the General Laws entitled "Uncompensated Care" is

4-6

hereby amended by adding thereto the following section:

4-7

     40-8.3-10. Outpatient adjustment payments. – Effective July 1, 2012 and for each

4-8

subsequent year, the executive office of health and human services is hereby authorized and

4-9

directed to amend its regulations for reimbursement to hospitals for outpatient services as

4-10

follows:

4-11

     (a) Each hospital in the state of Rhode Island, as defined in subdivision 23-17-

4-12

38.19(b)(1), shall receive a quarterly adjustment payment each state fiscal year of an amount

4-13

determined as follows:

4-14

     (1) Determine the percent of the state’s total Medicaid outpatient and emergency

4-15

department services (exclusive of physician services) provided by each hospital during each

4-16

hospital’s prior fiscal year;

4-17

     (2) Determine the sum of all Medicaid payments to hospitals made for outpatient and

4-18

emergency department services (exclusive of physician services) provided during each hospital’s

4-19

prior fiscal year;

4-20

     (3) Multiply the sum of all Medicaid payments as determined in subdivision (2) by

4-21

seventy-four and ninety-seven hundredths percent (74.97%) and then multiply that result by each

4-22

hospital’s percentage of the state’s total Medicaid outpatient and emergency department services

4-23

as determined in subdivision (1) to obtain the total outpatient adjustment for each hospital to be

4-24

paid each year;

4-25

     (4) Pay each hospital on or before July 20, October 20, January 20, and April 20 one

4-26

quarter (1/4) of its total outpatient adjustment as determined in subdivision (3) above.

4-27

     (b) The amounts determined in subsection (a) are in addition to Medicaid outpatient

4-28

payments and emergency services payments (exclusive of physician services) paid to hospitals in

4-29

accordance with current state regulation and the Rhode Island Plan for Medicaid Assistance

4-30

pursuant to Title XIX of the Social Security Act and are not subject to recoupment or settlement.

4-31

     SECTION 3. This article shall take effect upon passage.