Conn. Agencies Regs. § 17-312-107 - Disproportionate share adjustment
For purposes of this regulation, the following definitions apply:
(a)
Definitions
(1) "Medicaid inpatient utilization"-For a
hospital, the total number of its Medicaid inpatient days including newborn in
a cost reporting period, divided by the total number of the hospital's
inpatient days including newborn in that same period.
(2) "Low-income utilization rate"-For a
hospital, the sum (expressed as a percentage) of the fraction, calculated as
follows:
(A) Total Medicaid inpatient revenues
paid to the hospital, plus the amount of the cash subsidies received directly
from State and local governments in a cost reporting period, divided by the
total amount of revenues of the hospital for inpatient services (including the
amount of such cash subsidies) in the same cost reporting period;
and,
(B) The total amount of the
hospital's charges for inpatient hospital services attributable to charity care
(care provided to individuals who have no source of payment, third-party or
personal resources) in a cost reporting period, divided by the total amount of
the hospital's charges for inpatient services in the hospital in the same
period. The total inpatient charges attributed to charity care shall not
include contractual allowances and discounts (other than for indigent patients
not eligible for Medical assistance under an approved Medicaid State plan) that
is, reductions in charges given to other third-party payers, such as HMOs,
Medicare or Blue Cross.
(b) Effective for the fiscal year ending
September 30, 1989 and subsequent fiscal years hospitals which meet at least
one of the following criteria shall be eligible for a disproportionate share
adjustment.
(1) A Medicaid inpatient
utilization rate at least one standard deviation above the mean Medicaid
inpatient utilization rate for hospitals receiving Medicaid payments in the
State.
(2) A low-income inpatient
utilization rate exceeding 25 percent.
(c) If the hospital meets one of the criteria
in subsection (b), it must also have at least two obstetricians with staff
privileges at the hospital who have agreed to provide obstetric services to
individuals entitled to such services under the State Medicaid plan.
(d) The Department shall determine from
available Medicaid cost reports which hospitals meet the criteria of subsection
(b) (1). Hospitals that believe they meet the criteria of subsection (b) (2)
must file with the Department by August 1st of each year their calculation that
the low-income inpatient utilization rate exceeded 25 percent for the most
recently completed fiscal year.
(e)
In calculating interim rates pursuant to section
17-312-103
of these regulations, hospitals that qualify for a disproportionate share
adjustment shall have its estimated TEFRA target amount increased by the
available Medicare disproportionate share adjustment percentage as determined
by the Medicare fiscal intermediary.
(f) A hospital that received an adjustment as
a disproportionate share hospital in its interim per diem rate shall receive in
its final target rate calculated pursuant to Section
17-312-104
of these regulations the same adjustment percentage as set forth in subsection
(e) above.
Notes
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