Ariz. Admin. Code § R9-22-730 - Health Assessment Fund - Hospital Assessment
A. For purposes of this Section, the
following terms are defined as provided below unless the context specifically
requires another meaning:
1. "2022 Medicare
Cost Report" means: The Medicare Cost Report for the hospital fiscal year
ending in calendar year 2022 as reported in the CMS Healthcare Provider Cost
Reporting Information System (HCRIS) release dated October 7, 2023.
2. "2022 Uniform Accounting Report" means the
Uniform Accounting Report submitted to the Arizona Department of Health
Services as of January 8, 2024 for the hospital's fiscal year ending in
calendar year 2022.
3. "Quarter"
means the three month period beginning January 1, April 1, July 1, and October
1 of each year.
4. A "new hospital"
means a licensed hospital that did not hold a license from the Arizona
Department of Health Services prior to January 2, 2024.
5. "Outpatient Net Patient Revenues" means an
amount, calculated using data in the hospital's 2022 Uniform Accounting Report
or other data sources specified by subsection (N), that is equal to the
hospital's 2022 total net patient revenue multiplied by the ratio of the
hospital's 2022 gross outpatient revenue to the hospital's 2022 total gross
patient revenue.
B.
Beginning January 1, 2014, for each Arizona licensed hospital not excluded
under subsection (I) shall be subject to an assessment payable on a quarterly
basis. The assessment shall be levied against the legal owner of each hospital
as of the first day of the quarter, and except as otherwise required by
subsections (D), (E) and (F). For the period beginning October 1, 2024, the
assessment for each hospital shall be amount equal to the sum of:
(1) the number of discharges reported on the
hospital's 2022 Medicare Cost Report, excluding discharges reported on the
Medicare Cost Report as "Other Long Term Care Discharges," multiplied by the
following rates appropriate to the hospital's peer group; and
(2) the amount of outpatient net patient
revenues multiplied by the following rate appropriate to the hospital's peer
group:
1. $ 993.50 per discharge and 1.4871%
of outpatient net patient revenues for hospitals located in a county with a
population less than 500,000 that are designated as type: hospital, subtype:
short-term.
2. $ 993.50 per
discharge and 0.6196% of outpatient net patient revenues for hospitals
designated as type: hospital, subtype: critical access hospital.
3. $ 248.50 per discharge and 0.6196% of
outpatient net patient revenues for hospitals designated as type: hospital,
subtype: long term.
4. $ 248.50 per
discharge and 0.6196% of outpatient net patient revenues for hospitals
designated as type: hospital, subtype: psychiatric, that reported 2,500 or more
discharges on the 2022 Medicare Cost Report.
5. $ 794.75 per discharge and 1.6110% of
outpatient net patient revenues for hospitals designated as type: hospital,
subtype: short-term with 20% of total licensed beds licensed as pediatric,
pediatric intensive care and neonatal intensive care as reported in the
hospital's 2022 Uniform Accounting Report.
6. $ 894.00 per discharge and 1.8588% of
outpatient net patient revenues for hospitals designated as type: hospital,
subtype: short-term with at least 10% but less than 20% of total licensed beds
licensed as pediatric, pediatric intensive care and neonatal intensive care as
reported in the hospital's 2022 Uniform Accounting Report.
7. $ 198.75 per discharge and 0.4957% of
outpatient net patient revenues for hospitals designated as type: hospital,
subtype: children's.
8. $ 993.50
per discharge and 2.4785% of outpatient net patient revenues for hospitals
designated as type: hospital, subtype: short-term not included in another peer
group.
C. Peer
groups for the four quarters beginning October 1 of each year are established
based on hospital license type and subtype designated in the Provider &
Facility Database for Arizona Medical Facilities posted by the Arizona
Department of Health Services Division of Licensing Services on its website
January 2, 2024.
D. Notwithstanding
subsection (B), psychiatric discharges from a hospital that reported having a
psychiatric sub-provider in the hospital's 2022 Medicare Cost Report, are
assessed a rate of $ 248.50 for each discharge from the psychiatric
sub-provider as reported in the 2022 Medicare Cost Report. All discharges other
than those reported as discharges from the psychiatric sub-provider are
assessed at the rate required by subsection (B).
E. Notwithstanding subsection (B),
rehabilitative discharges from a hospital that reported having a rehabilitative
sub-provider in the hospital's 2022 Medicare Cost Report, are assessed a rate
of $0 for each discharge from the rehabilitative sub-provider as reported in
the 2022 Medicare Cost Report. All discharges other than those reported as
discharges from the rehabilitative sub-provider are assessed at the rate
required by subsection (B).
F.
Notwithstanding subsection (B), for any hospital that reported more than 22,800
discharges on the hospital's 2022 Medicare Cost Report, discharges in excess of
22,800 are assessed a rate of $ 99.50 for each discharge in excess of 22,800.
The initial 22,800 discharges are assessed at the rate required by subsection
(B).
G. Assessment notice. On or
before the 15th day of the first month of the quarter or upon CMS approval,
whichever is later, the Administration shall send to each hospital a
notification that the Hospital Assessment Fund assessment invoice is available
to be viewed on a secure website. The invoice shall include the hospital's peer
group assignment and the assessment due for the quarter.
H. Assessment due date. The Hospital
Assessment Fund assessment must be received by the Administration no later
than:
1. The 15th day of the second month of
the quarter or
2. In the event CMS
approves the assessment after the 15th day of the first month of the quarter,
30 days after notification by the Administration that the assessment invoice is
available.
I. Excluded
hospitals. The following hospitals are excluded from the assessment based on
the hospital's 2022 Medicare Cost Report and Provider & Facility Database
for Arizona Medical Facilities posted by the Arizona Department of Health
Services Division of Licensing Services on its website for January 2, 2024:
1. Hospitals owned and operated by the state,
the United States, or an Indian tribe.
2. Hospitals designated as type: hospital,
subtype: short-term that have a license number beginning "SH".
3. Hospitals designated as type: hospital,
subtype: psychiatric that reported fewer than 2,500 discharges on the 2022
Medicare Cost Report.
4. Hospitals
designated as type: hospital, subtype; rehabilitation.
5. Hospitals designated as type:
med-hospital, subtype: special hospitals.
6. Hospitals designated as type: hospital,
subtype: short-term located in a city with a population greater than one
million, which on average have at least 15 percent of inpatient days for
patients who reside outside of Arizona, and at least 50 percent of discharges
as reported on the 2022 Medicare Cost Report are reimbursed by
Medicare.
7. Hospitals designated
as type: hospital, subtype: short-term that have at least 25 percent Medicare
swing beds as percentage of total Medicare days, per the 2022 Medicare Cost
Report.
8. Hospitals designated as
type: hospital, subtype: short-term that are an urban public acute care
hospital.
J. New
hospitals. For hospitals that did not file a 2022 Medicare Cost Report because
of the date the hospital began operations:
1.
If the hospital was open on the January 2 preceding the October assessment
start date, the hospital assessment will begin on October 1 following the date
the hospital began operating.
2. If
the hospital began operating between January 3 and September 30, the assessment
will begin on October 1 of the following calendar year.
3. A hospital is not considered a new
hospital based on a change in ownership.
4. The assessment will be based on the
discharges reported in the hospital's first Medicare Cost Report and Uniform
Accounting Report, which includes 12 months-worth of data, except when any of
the following apply;
a. If there is not a
complete 12 months-worth of data available, the assessment will be based on the
annualized number of discharges from the date hospital operations began through
December 31 preceding the October assessment start date. The hospital shall
self-report the discharge data and all other data requested by the
Administration necessary to determine the appropriate assessment to the
Administration no later than January preceding the assessment start date for
the new hospitals. "Annualized" means divided by a ratio equal to the number of
months of data divided by 12 months.
b. If more than 12 months of data is
available, the assessment will be based on the most recent 12 months of
self-reported data, as of December 31;
5. For purposes of calculating subpart 4, if
a new hospital shares a Medicare Identification Number with an existing
hospital, the assessment amount will be based on self-reported data from the
new hospital instead of the Medicare Cost Report. The data shall include the
number of discharges and all other data requested by the Administration
necessary to determine the appropriate assessment.
6. For hospitals providing self-reported
data, described in subpart 4 and 5:
a.
Psychiatric discharges will be annualized to determine if subsections (B)(4) or
(I)(3) apply to the assessment amount.
b. Discharges will be annualized to determine
if subsection (F) applies to the assessment amount.
K. Changes of ownership. The
parties to a change of ownership shall promptly provide written notice to the
Administration of a change of ownership and any agreement regarding the payment
of the assessment. The assessed amount will continue at the same amount applied
to the prior owner. Assessments are the responsibility of the owner of record
as of the first day of the quarter; however, this rule is not intended to
prohibit the parties to a change of ownership from entering into an agreement
for a new owner to assume the assessment responsibility of the owner of record
as of the first day of the prior quarter.
L. Hospital closures. Hospitals that close
shall pay a proportion of the quarterly assessment equal to that portion of the
quarter during which the hospital operated.
M. Required information for the inpatient
assessment. For any hospital that has not filed a 2022 Medicare Cost report, or
if the 2022 Medicare Cost report does not include the reliable information
sufficient for the Administration to calculate the inpatient assessment, the
Administration shall use data reported on the 2022 Uniform Accounting Report
filed by the hospital in place of the 2022 Medicare Cost report to calculate
the assessment. If the 2022 Uniform Accounting Report filed by the hospital
does not include reliable information sufficient for the Administration to
calculate the inpatient assessment amounts, the hospital shall provide the
Administration with data specified by the Administration necessary in place of
the 2022 Medicare Cost report to calculate the assessment.
N. Required information for the outpatient
assessment. For any hospital that has not filed a 2022 Uniform Accounting
Report, if the 2022 Uniform Accounting Report does not include reliable
information sufficient for the Administration to calculate the outpatient
assessment amounts, or if the 2022 Uniform Accounting Report does not reconcile
to 2022 Audited Financial Statements, the Administration shall use the data
reported on 2022 Audited Financial Statements to calculate the outpatient
assessment. If the 2022 Audited Financial Statements do not include the
reliable information sufficient for the Administration to calculate the
outpatient assessment, the Administration shall use data reported on the 2022
Medicare Cost report. If the Medicare Cost report does not include reliable
information sufficient for the Administration to calculate the outpatient
assessment amounts, the hospital shall provide the Administration with data
specified by the Administration necessary in place of the 2022 Medicare Cost
report to calculate the outpatient assessment.
O. The Administration will review and update
as necessary rates and peer groups periodically to ensure the assessment is
sufficient to fund the state match obligation to cover the cost of the
populations as specified in 36-2901.08.
P. Enforcement. If a hospital does not comply
with this section, the director may suspend or revoke the hospital's provider
agreement. If the hospital does not comply within 180 days after the hospital's
provider agreement is suspended or revoked, the director shall notify the
director of the Department of Health Services who shall suspend or revoke the
hospital's license.
Notes
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