TITLE 40
Human services

CHAPTER 40-8.3
Uncompensated Care

SECTION 40-8.3-2


§ 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, 2015, the period from October 1, 2013, through September 30, 2014, and for any fiscal year ending after September 30, 2016, the period from October 1, 2014, through September 30, 2015.

(2) "Medicaid 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 and shall mean the actual facilities and buildings in existence in Rhode Island, licensed pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on that license, regardless of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital conversions) and § 23-17-6(b) (change in effective control), that provides short-term acute inpatient and/or outpatient care to persons who require definitive diagnosis and treatment for injury, illness, disabilities, or pregnancy. Notwithstanding the preceding language, the negotiated Medicaid managed care payment rates for a court-approved purchaser that acquires a hospital through receivership, special mastership, or other similar state insolvency proceedings (which court-approved purchaser is issued a hospital license after January 1, 2013) shall be based upon the newly negotiated rates between the court-approved purchaser and the health plan, and such rates shall be effective as of the date that the court-approved purchaser and the health plan execute the initial agreement containing the newly negotiated rate. The rate-setting methodology for inpatient hospital payments and outpatient hospital payments set forth in §§ 40-8-13.4(b)(1)(ii)(C) and 40-8-13.4(b)(2), respectively, shall thereafter apply to negotiated increases for each annual twelve-month (12) period as of July 1 following the completion of the first full year of the court-approved purchaser's initial Medicaid managed care contract.

(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, September 30, 2011, September 30, 2012, September 30, 2013, September 30, 2014, September 30, 2015, September 30, 2016, and September 30, 2017, shall be deemed to be five and thirty hundredths percent (5.30%).

History of Section.
(P.L. 1996, ch. 100, art. 42, § 1; P.L. 1997, ch. 30, art. 21, § 1; P.L. 2000, ch. 55, art. 16, § 1; P.L. 2001, ch. 77, art. 25, § 1; P.L. 2002, ch. 65, art. 21, § 1; P.L. 2003, ch. 376, art. 19, § 1; P.L. 2004, ch. 595, art. 9, § 1; P.L. 2005, ch. 117, art. 9, § 1; P.L. 2006, ch. 246, art. 13, § 1; P.L. 2007, ch. 73, art. 19, § 1; P.L. 2008, ch. 100, art. 19, § 1; P.L. 2009, ch. 68, art. 19, § 1; P.L. 2010, ch. 23, art. 15, § 1; P.L. 2011, ch. 151, art. 18, § 1; P.L. 2012, ch. 241, art. 15, § 1; P.L. 2013, ch. 144, art. 12, § 1; P.L. 2014, ch. 145, art. 17, § 1; P.L. 2015, ch. 141, art. 5, § 14; P.L. 2016, ch. 142, art. 7, § 3.)