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1 | ARTICLE 17 | |
2 | RELATING TO HOSPITAL UNCOMPENSATED CARE | |
3 | SECTION 1. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter 40-8.3 | |
4 | entitled “Uncompensated Care” are hereby amended to read as follows: | |
5 | 40-8.3-2. Definitions. As used in this chapter: | |
6 | (1) "Base year" means, for the purpose of calculating a disproportionate share payment for | |
7 | any fiscal year ending after September 30, 2018 2019, the period from October 1, 2016 2017, | |
8 | through September 30, 2017 2018, and for any fiscal year ending after September 30, 2019 2020, | |
9 | the period from October 1, 2016 2017, through September 30, 2017 2018. | |
10 | (2) "Medicaid inpatient utilization rate for a hospital" means a fraction (expressed as a | |
11 | percentage), the numerator of which is the hospital's number of inpatient days during the base year | |
12 | attributable to patients who were eligible for medical assistance during the base year and the | |
13 | denominator of which is the total number of the hospital's inpatient days in the base year. | |
14 | (3) "Participating hospital" means any nongovernment and nonpsychiatric hospital that: | |
15 | (i) Was licensed as a hospital in accordance with chapter 17 of title 23 during the base year | |
16 | and shall mean the actual facilities and buildings in existence in Rhode Island, licensed pursuant to | |
17 | § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on that license, regardless | |
18 | of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital conversions) and § 23- | |
19 | 17-6(b) (change in effective control), that provides short-term, acute inpatient and/or outpatient | |
20 | care to persons who require definitive diagnosis and treatment for injury, illness, disabilities, or | |
21 | pregnancy. Notwithstanding the preceding language, the negotiated Medicaid managed-care | |
22 | payment rates for a court-approved purchaser that acquires a hospital through receivership, special | |
23 | mastership, or other similar state insolvency proceedings (which court-approved purchaser is issued | |
24 | a hospital license after January 1, 2013), shall be based upon the newly negotiated rates between | |
25 | the court-approved purchaser and the health plan, and such rates shall be effective as of the date | |
26 | that the court-approved purchaser and the health plan execute the initial agreement containing the | |
27 | newly negotiated rate. The rate-setting methodology for inpatient hospital payments and outpatient | |
28 | hospital payments set forth in §§ 40-8-13.4(b)(1)(ii)(C) and 40-8-13.4(b)(2), respectively, shall | |
29 | thereafter apply to negotiated increases for each annual twelve-month (12) period as of July 1 | |
30 | following the completion of the first full year of the court-approved purchaser's initial Medicaid | |
31 | managed-care contract; | |
32 | (ii) Achieved a medical assistance inpatient utilization rate of at least one percent (1%) | |
33 | during the base year; and | |
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1 | (iii) Continues to be licensed as a hospital in accordance with chapter 17 of title 23 during | |
2 | the payment year. | |
3 | (4) "Uncompensated-care costs" means, as to any hospital, the sum of: (i) The cost incurred | |
4 | by such hospital during the base year for inpatient or outpatient services attributable to charity care | |
5 | (free care and bad debts) for which the patient has no health insurance or other third-party coverage | |
6 | less payments, if any, received directly from such patients; and (ii) The cost incurred by such | |
7 | hospital during the base year for inpatient or out-patient services attributable to Medicaid | |
8 | beneficiaries less any Medicaid reimbursement received therefor; multiplied by the uncompensated | |
9 | care index. | |
10 | (5) "Uncompensated-care index" means the annual percentage increase for hospitals | |
11 | established pursuant to § 27-19-14 for each year after the base year, up to and including the payment | |
12 | year; provided, however, that the uncompensated-care index for the payment year ending | |
13 | September 30, 2007, shall be deemed to be five and thirty-eight hundredths percent (5.38%), and | |
14 | that the uncompensated-care index for the payment year ending September 30, 2008, shall be | |
15 | deemed to be five and forty-seven hundredths percent (5.47%), and that the uncompensated-care | |
16 | index for the payment year ending September 30, 2009, shall be deemed to be five and thirty-eight | |
17 | hundredths percent (5.38%), and that the uncompensated-care index for the payment years ending | |
18 | September 30, 2010, September 30, 2011, September 30, 2012, September 30, 2013, September | |
19 | 30, 2014, September 30, 2015, September 30, 2016, September 30, 2017, September 30, 2018, | |
20 | September 30, 2019, and September 30, 2020, and September 30, 2021 shall be deemed to be five | |
21 | and thirty hundredths percent (5.30%). | |
22 | 40-8.3-3. Implementation. (a) For federal fiscal year 2018, commencing on October 1, | |
23 | 2017, and ending September 30, 2018, the executive office of health and human services shall | |
24 | submit to the Secretary of the U.S. Department of Health and Human Services a state plan | |
25 | amendment to the Rhode Island Medicaid DSH Plan to provide: | |
26 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of $138.6 | |
27 | million, shall be allocated by the executive office of health and human services to the Pool D | |
28 | component of the DSH Plan; and | |
29 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
30 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
31 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
32 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
33 | payments shall be made on or before July 10, 2018, and are expressly conditioned upon approval | |
34 | on or before July 5, 2018, by the Secretary of the U.S. Department of Health and Human Services, | |
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1 | or his or her authorized representative, of all Medicaid state plan amendments necessary to secure | |
2 | for the state the benefit of federal financial participation in federal fiscal year 2018 for the | |
3 | disproportionate share payments. | |
4 | (b) (a) For federal fiscal year 2019, commencing on October 1, 2018, and ending | |
5 | September 30, 2019, the executive office of health and human services shall submit to the Secretary | |
6 | of the U.S. Department of Health and Human Services a state plan amendment to the Rhode Island | |
7 | Medicaid DSH Plan to provide: | |
8 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
9 | $142.4 million, shall be allocated by the executive office of health and human services to the Pool | |
10 | D component of the DSH Plan; and | |
11 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
12 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
13 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
14 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
15 | payments shall be made on or before July 10, 2019, and are expressly conditioned upon approval | |
16 | on or before July 5, 2019, by the Secretary of the U.S. Department of Health and Human Services, | |
17 | or his or her authorized representative, of all Medicaid state plan amendments necessary to secure | |
18 | for the state the benefit of federal financial participation in federal fiscal year 2019 for the | |
19 | disproportionate share payments. | |
20 | (c) (b) For federal fiscal year 2020, commencing on October 1, 2019, and ending | |
21 | September 30, 2020, the executive office of health and human services shall submit to the Secretary | |
22 | of the U.S. Department of Health and Human Services a state plan amendment to the Rhode Island | |
23 | Medicaid DSH Plan to provide: | |
24 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
25 | $142.4 $142.3 million, shall be allocated by the executive office of health and human services to | |
26 | the Pool D component of the DSH Plan; and | |
27 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
28 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
29 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
30 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
31 | payments shall be made on or before July 13, 2020, and are expressly conditioned upon approval | |
32 | on or before July 6, 2020, by the Secretary of the U.S. Department of Health and Human Services, | |
33 | or his or her authorized representative, of all Medicaid state plan amendments necessary to secure | |
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1 | for the state the benefit of federal financial participation in federal fiscal year 2020 for the | |
2 | disproportionate share payments. | |
3 | (c) For federal fiscal year 2021, commencing on October 1, 2020, and ending September | |
4 | 30, 2021, the executive office of health and human services shall submit to the Secretary of the | |
5 | U.S. Department of Health and Human Services a state plan amendment to the Rhode Island | |
6 | Medicaid DSH Plan to provide: | |
7 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
8 | $142.3 million, shall be allocated by the executive office of health and human services to the Pool | |
9 | D component of the DSH Plan; and | |
10 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
11 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
12 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
13 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
14 | payments shall be made on or before July 13, 2021, and are expressly conditioned upon approval | |
15 | on or before July 6, 2021, by the Secretary of the U.S. Department of Health and Human Services, | |
16 | or his or her authorized representative, of all Medicaid state plan amendments necessary to secure | |
17 | for the state the benefit of federal financial participation in federal fiscal year 2021 for the | |
18 | disproportionate share payments. | |
19 | (d) No provision is made pursuant to this chapter for disproportionate-share hospital | |
20 | payments to participating hospitals for uncompensated-care costs related to graduate medical | |
21 | education programs. | |
22 | (e) The executive office of health and human services is directed, on at least a monthly | |
23 | basis, to collect patient-level uninsured information, including, but not limited to, demographics, | |
24 | services rendered, and reason for uninsured status from all hospitals licensed in Rhode Island. | |
25 | SECTION 2. This article shall take effect as of July 1, 2020. | |
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