ARTICLE 19 SUBSTITUTE A AS
AMENDED
RELATING TO
HOSPITAL UNCOMPENSATED CARE
SECTION 1. Sections 40-8.3-2 and 40-8.3-3 of the General
Laws in Chapter 40-8.3
entitled “Uncompensated Care” are hereby amended to read as
follows:
40-8.3-2. Definitions. -- As used in this chapter:
(1) "Base
year" means for the purpose of calculating a disproportionate share
payment for
any fiscal year ending after September 30, 2007, the
period from October 1, 2005 through
September 30, 2006, and for any fiscal year ending
after September 30, 2008, the period from
October 1, 2006 through September 30, 2007.
(2) "Medical
assistance inpatient utilization rate for a hospital" means a fraction
(expressed as a percentage)
the numerator of which is the hospital's number of inpatient days
during the base year attributable to patients who were
eligible for medical assistance during the
base year and the denominator of which is the total number
of the hospital's inpatient days in the
base year.
(3) "Participating
hospital" means any nongovernment and nonpsychiatric hospital that:
(i) was
licensed as a hospital in accordance with chapter 17 of title 23 during the
base year; (ii)
achieved a medical assistance inpatient utilization rate of at
least one percent (1%) during the
base year; and (iii) continues to be licensed as a
hospital in accordance with chapter 17 of title 23
during the payment year.
(4) "Uncompensated
care costs" means, as to any hospital, the sum of: (i)
the cost
incurred by such hospital during the base year for inpatient
or outpatient services attributable to
charity care (free care and bad debts) for which the patient
has no health insurance or other third-
party coverage less payments, if any, received directly from
such patients; and (ii) the cost
incurred by such hospital during the base year for inpatient
or out-patient services attributable to
Medicaid beneficiaries less any Medicaid reimbursement
received therefor; multiplied by the
uncompensated care index.
(5) "Uncompensated
care index" means the annual percentage increase for hospitals
established pursuant to § 27-19-14 for each year after the base
year, up to and including the
payment year, provided, however, that the uncompensated care
index for the payment year ending
September 30, 2007 shall be deemed to be five and
thirty-eight hundredths percent (5.38%), and
that the uncompensated care index for the payment year
ending September 30, 2008 shall be
deemed to be five and forty-seven hundredths percent
(5.47%), and that the uncompensated care
index for the payment year ending September 30, 2009 shall
be deemed to be five and thirty-eight
hundredths percent (5.38%). , and that the
uncompensated care index for the payment year ending
September 30, 2010 shall be deemed to be five and
thirty hundredths percent (5.30%).
40-8.3-3. Implementation. -- (a) For the fiscal year commencing on October 1, 2007
and ending September 30, 2008, the department of human
services shall submit to the Secretary
of the U.S. Department of Health and Human Services a
state plan amendment to the Rhode
Island Medicaid state plan for disproportionate share
hospital payments (DSH Plan) to provide:
(1) Disproportionate share hospital payments to all
participating hospitals not to exceed
an aggregate limit of $105.6 $99.5
million, to be allocated by the department to the Pool A, Pool
C and Pool D components of the DSH Plan;
(2) That the Pool D
allotment shall be distributed among the participating hospitals in
direct proportion to the individual participating hospitals
uncompensated care costs for the base
year inflated by the uncompensated care index to the total
uncompensated care costs for the base
year inflated by uncompensated care index for all participating
hospitals. The disproportionate
share payments shall be made on or before July 14, 2008 and
are expressly conditioned upon
approval on or before July 7, 2008 the Secretary of the U.S.
Department of Health and Human
Services, or his or her authorized representative, of
all Medicaid state plan amendments necessary
to secure for the state the benefit of federal financial
participation in federal fiscal year 2008 for
the disproportionate share payments.
(b)
For the fiscal year commencing on October 1, 2008 and ending September 30,
2009, the department of human services shall submit to
the Secretary of the U.S. Department of
Health and Human Services a state plan amendment to
the Rhode Island Medicaid state plan for
disproportionate share hospital payments (DSH Plan) to provide:
(1)
That the disproportionate share hospital payments to all participating
hospitals not
to exceed an aggregate limit of $105.5 $114.7
million, to be allocated by the department to the
Pool A, Pool C and Pool D
components of the DSH Plan;
(2)
That the Pool D allotment shall be distributed among the participating
hospitals in
direct proportion to the individual participating hospital's
uncompensated care costs for the base
year, inflated by the uncompensated care index to the
total uncompensated care costs for the base
year inflated by uncompensated care index for all
participating hospitals. The disproportionate
share payments shall be made on or before July 13, 2009 and
are expressly conditioned upon
approval on or before July 6, 2009 by the Secretary of the
U.S. Department of Health and Human
Services, or his or her authorized representative, of
all Medicaid state plan amendments necessary
to secure for the state the benefit of federal financial
participation in federal fiscal year 2009 for
the disproportionate share payments.
(c) For the fiscal
year commencing on October 1, 2009 and ending September 30, 2010,
the department of human services shall submit to the
Secretary of the
and Human Services a state plan amendment to the
disproportionate share hospital payments (DSH Plan) to provide:
(1) That the
disproportionate share hospital payments to all participating hospitals not to
exceed an aggregate limit of $117.8 million, to be allocated
by the department to the Pool A, Pool
C and Pool D components of the DSH Plan;
(2) That the Pool D
allotment shall be distributed among the participating hospitals in
direct proportion to the individual participating hospital's
uncompensated care costs for the base
year, inflated by the uncompensated care index to the
total uncompensated care costs for the base
year inflated by uncompensated care index for all
participating hospitals. The disproportionate
share payments shall be made on or before July 12, 2010 and
are expressly conditioned upon
approval on or before July 5, 2010 by the Secretary of the
Services, or his or her authorized representative, of
all Medicaid state plan amendments necessary
to secure for the state the benefit of federal financial
participation in federal fiscal year 2010 for
the disproportionate share payments.
(c)
(d) No provision is made pursuant to this
chapter for disproportionate share hospital
payments to participating hospitals for uncompensated care
costs related to graduate medical
education programs.
SECTION 2. Chapter 40-8.3 of the General Laws entitled
"Uncompensated Care" is
hereby amended by adding thereto the following sections:
40-8.3-5.
Hospital payments. -- Due to the high ratio of
unqualified uncompensated care
expenses to qualified uncompensated care expenses, the
department of human services is hereby
authorized and directed to pay during state fiscal years 2009
and 2010 from revenues derived
from taxes imposed in accordance with section 44-17-1: (1)
acute care hospitals in
County the amount of five hundred thousand dollars
($500,000) to
seven hundred and fifty thousand dollars ($750,000) to The
hospital in
40-8.3-6.
Outpatient adjustment payments for fiscal year 2009. --
Effective July 1,
2008, the department of human services is hereby
authorized and directed to amend its
regulations and the
Social Security Act for reimbursement to hospitals for
outpatient service as follows:
Hospitals
-- Outpatient adjustment payments.
(a) Each hospital in
the state of
shall receive an adjustment payment during state fiscal
year 2009 of an amount determined as
follows:
(1) Determine the
percent of the state's total Medicaid outpatient and emergency
department services (exclusive of physician services) provided
by each hospital during the
hospital's fiscal year ending during 2007;
(2) Determine the
sum of all Medicaid payments to hospitals made for outpatient and
emergency department services (exclusive of physician services)
provided during each hospital's
fiscal year ending during 2007;
(3) Multiply the sum
of all Medicaid payments as determined in subdivision (2) by fifty-
six and five hundredths percent (56.05%) and then
multiply that result by each hospital's
percentage of the state's total Medicaid outpatient and
emergency department services as
determined in subdivision (1) to obtain the total outpatient
adjustment for each hospital to be paid
in SFY 2009;
(4) Pay each hospital
on its total outpatient adjustment as determined in subdivision (3)
above.
(b) The amounts
determined in subsection (a) are in addition to Medicaid outpatient
payments and emergency services payments (exclusive of
physician services) paid to hospitals in
accordance with current state regulation and the
pursuant to Title XIX of the Social Security Act and are not
subject to recoupment or settlement.
(c) The payments are
expressly conditioned upon approval by the secretary of the United
States Department of Health and Human Services, or his
or her authorized representative, of any
Medicaid state plan amendment necessary to secure for
the state the benefit of federal financial
participation in federal fiscal year 2009 for such payments, such
amendment to be filed not later
than July 9, 2008.
40-8.3-7.
Outpatient adjustment payments for fiscal year 2010. --
Effective July 1,
2009, the department of human services is hereby
authorized and directed to amend its
regulations and the
Social Security Act for reimbursement to hospitals for
outpatient services as follows:
Hospitals
-- Outpatient adjustment payments.
(a) Each hospital in
the state of
shall receive a quarterly adjustment payment during state
fiscal year 2010 of an amount
determined as follows:
(1) Determine the
percent of the state’s total Medicaid outpatient and emergency
department services (exclusive of physician services) provided
by each hospital during the
hospital’s fiscal year ending during 2008;
(2) Determine the sum
of all Medicaid payments to hospitals made for outpatient and
emergency department services (exclusive of physician services)
provided during each hospital’s
fiscal year ending during 2008;
(3) Multiply the sum
of all Medicaid payments as determined in subdivision (2) by
seventy-seven and forty-one hundredths percent (77.41%) and
then multiply that result by each
hospital's percentage of the state's total Medicaid outpatient
and emergency department services
as determined in subdivision (1) to obtain the total
outpatient adjustment for each hospital to be
paid in SFY 2010;
(4) Pay each
hospital on or about July 20, 2009, October 20, 2009, January 20, 2010, and
April 20, 2010 one-quarter (.25) of its total
outpatient adjustment as determined in subdivision (3)
above.
(b) The amounts
determined in subsection (a) are in addition to Medicaid outpatient
payments and emergency services payments (exclusive of
physician services) paid to hospitals in
accordance with current state regulation and the
pursuant to Title XIX of the Social Security Act and are not
subject to recoupment or settlement.
SECTION 3. This article shall take effect upon passage.