ARTICLE 18 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, 2009 2010, the period from October 1, 2007 2008

through September 30, 2008 2009, and for any fiscal year ending after September 30, 2010 2011,

the period from October 1, 2008 2009 through September 30, 2009 2010.

     (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 years ending

September 30, 2010 and, September 30, 2011 and September 30, 2012 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, 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 $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.

      (b)(a) 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 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 $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 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 2010 for

the disproportionate share payments.

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

2011, 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 $125.4 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 18, 2011 and are expressly conditioned upon

approval on or before July 11, 2011 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

2011 for the disproportionate share payments.

     (c) For the fiscal year commencing on October 1, 2011 and ending September 30, 2012,

the executive office of health and human services 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 $129.8 million, shall be allocated by the executive office of health

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

     (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 16, 2012 and are expressly conditioned upon

approval on or before July 9, 2012 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 2012 for

the disproportionate share payments.

     (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 section:

 

     40-8.3-9. Outpatient adjustment payments for fiscal year 2012. -- Effective July 1,

2011, the executive office of health and human services is hereby authorized and directed to

amend its regulations for reimbursement to hospitals for outpatient services as follows:

      Hospitals -- Outpatient adjustment payments.

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

38.19(b)(1), shall receive a quarterly adjustment payment during state fiscal year 2012 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 each

hospital's fiscal year ending during 2010;

     (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 2010.

     (3) Multiply the sum of all Medicaid payments as determined in (2) by 72.57 percent and

then multiply that result by each hospital's percentage of the state's total Medicaid outpatient and

emergency department services as determined in (1) to obtain the total outpatient adjustment for

each hospital to be paid in SFY 2012;

     (4) Pay each hospital on or before July 20, 2011, October 20, 2011, January 20, 2012, and

April 20, 2012 one-quarter of its total outpatient adjustment as determined in (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 Rhode Island Plan for Medicaid Assistance

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

 

     SECTION 3. Section 40-8.3-5 of the General Laws in Chapter 40-8.3 entitled

"Uncompensated Care" is hereby amended to read as follows:

 

     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 by September 1, 2010 from revenues derived from taxes imposed

in accordance with section 44-17-1: (1) acute care hospitals in Washington County the amount of

five hundred thousand dollars ($500,000) to South County Hospital, and seven hundred and fifty

thousand dollars ($750,000) to The Westerly Hospital; (2) any acute care hospital in Kent County

the amount of eight hundred thousand dollars ($800,000); and (3) Miriam Hospital the amount of

one million six hundred thousand dollars ($1,600,000). The department of human services is

authorized and directed to pay four million seven hundred fifty thousand dollars ($4,750,000)

during state fiscal year 2011 to the following hospitals: one million seven hundred seventy-eight

thousand eight hundred forty-three dollars ($1,778,843) to Kent Hospital; six hundred and forty-

two thousand three hundred forty dollars ($642,340) to Saint Joseph 's Hospital; one million one

hundred thirty-one thousand, nine hundred twenty-nine dollars ($1,131,929) to Miriam Hospital;

four hundred thirty-eight thousand and four hundred eighty-two dollars ($438,482) to South

County Hospital; two hundred ninety seven thousand eight hundred and six dollars ($297,806) to

Westerly Hospital; one hundred thirty-three thousand and six hundred seventy-two dollars

($133,672) to Newport Hospital; one hundred seventy thousand nine hundred and sixty-four

dollars ($170,964) to Butler Hospital; and one hundred fifty-five thousand and nine hundred

sixty-three dollars ($155,963) to Bradley Hospital of Rhode Island. The department of human

services is authorized to pay five hundred thousand dollars ($500,000) to South County Hospital

and five hundred thousand dollars ($500,000) to Westerly Hospital in state fiscal year 2012

 

     SECTION 4. This Article shall take effect upon passage.