Current through Register Vol. 30, No. 38, September 20, 2024
A. For purposes of this Section, terms are
the same as defined in A.A.C.
R9-22-730 as provided below unless
the context specifically requires another meaning:
B. Beginning October 1, 2023, 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, 2023, the assessment for each hospital shall be
amount equal to the sum of:
(1) the number of
discharges reported on the hospital's 2021 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. $ 245.50 per
discharge and 3.5063% 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.
$ 245.50 per discharge and 1.4610% of outpatient net patient revenues for
hospitals designated as type: hospital, sub type: critical access hospital.
3. $ 61.50 per discharge and
1.4610% of outpatient net patient revenues for hospitals designated as type:
hospital, subtype: long term.
4. $
61.50 per discharge and 1.4610% of outpatient net patient revenues for
hospitals designated as type: hospital, subtype: psychiatric, that reported
2,500 or more discharges on the 2021 Medicare Cost Report.
5. $ 196.50 per discharge and 3.7985% 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 2021 Uniform Accounting Report.
6. $ 221.00 per discharge and 4.3829% 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 2021 Uniform Accounting Report.
7. $ 49.25 per discharge and 1.1688% of
outpatient net patient revenues for hospitals designated as type: hospital,
subtype: children's.
8. $ 245.50
per discharge and 5.8439% 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, 2023.
D.
Notwithstanding subsection (B), psychiatric discharges from a hospital that
reported having a psychiatric sub-provider in the hospital's 2021 Medicare Cost
Report, are assessed a rate of $ 61.50 for each discharge from the psychiatric
sub-provider as reported in the 2021 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 2021 Medicare Cost Report, are assessed a rate
of $0 for each discharge from the rehabilitative sub-provider as reported in
the 2021 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 23,000
discharges on the hospital's 2021 Medicare Cost Report, discharges in excess of
23,000 are assessed a rate of $ 24.75 for each discharge in excess of 23,000.
The initial 23,000 discharges are assessed at the rate required by subsection
(B).
G. Assessment notice. On or
before the 10th 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 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 assessment must be received by the Administration no
later than the 10th day of the second month of the quarter.
I. Excluded hospitals. The following
hospitals are excluded from the assessment based on the hospital's 2021
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, 2023:
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 2021
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 2021 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 2021 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 2021 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 June 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
2021 Medicare Cost report, or if the 2021 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 2021
Uniform Accounting Report filed by the hospital in place of the 2021 Medicare
Cost report to calculate the assessment. If the 2021 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 2021 Medicare Cost report to calculate the
assessment.
N. Required
information for the outpatient assessment. For any hospital that has not filed
a 2021 Uniform Accounting Report, if the 2021 Uniform Accounting Report does
not include reliable information sufficient for the Administration to calculate
the outpatient assessment amounts, or if the 2021 Uniform Accounting Report
does not reconcile to 2021 Audited Financial Statements, the Administration
shall use the data reported on 2021 Audited Financial Statements to calculate
the outpatient assessment. If the 2021 Audited Financial Statements do not
include the reliable information sufficient for the Administration to calculate
the outpatient assessment, the Administration all use data reported on the 2021
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 2021 Medicare Cost
report to calculate the outpatient assessment.
O. 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.
