Current through Register Vol. 49, No. 9, September, 2024
Section
II
Hospital/Critical Access Hospital (CAH)/End Stage Renal
Disease (ESRD)
250.622
Arkansas
State Operated Teaching Hospital Adjustment
Effective May 9, 2000, Arkansas State Operated Teaching
Hospitals qualify for an inpatient rate adjustment.
A. The adjustment shall result in total
payments to the hospitals that are equal to but not in excess of the individual
facility's Medicare-related upper payment limit.
B. The adjustment is calculated as follows:
1. Using the most current audited data,
Arkansas Medicaid determines each State Operated Teaching Hospital's base
Medicare per discharge rate and base Medicaid per-discharge rate.
a. Arkansas Medicaid will use the date of the
Medicaid Notice of Provider Reimbursement (NPR) received by the Division of
Medical Services from the Medicare Intermediary to determine the most recent
audited cost report period for rate adjustment purposes.
b. The most current audited cost report
period is used when an earlier period's NPR is finalized after a later
period's.
c. In order to be used to
calculate the rate adjustment amount, the Medicaid NPR received from the
Medicare Intermediary must be dated before July 1 of the state fiscal year
(SFY) for which the adjustment payments will be made.
2. The base per-discharge rates are trended
forward to the current fiscal year using an annual Consumer Price Index
inflation factor.
3. Once the
per-discharge rates have been trended forward, the Medicare per-discharge rate
is divided by the Medicare case mix index and the Medicaid per-discharge rate
is divided by the Medicaid case mix index.
a.
The Medicare case mix index reflects the hospital's average diagnosis related
group (DRG) weight for Medicare patients.
b. The Medicaid case mix index reflects the
hospital's average DRG weight for Medicaid patients using the Medicare
DRGs.
4. The base
Medicaid per-discharge rate is subtracted from the base Medicare per discharge
rate.
5. The difference is
multiplied by the hospital's Medicaid case mix index.
6. The adjusted difference is multiplied by
the number of Medicaid discharges at the hospital for the most recent fiscal
year.
7. The result is the amount
of the annual State Operated Teaching Hospital Adjustment.
8. Payment is made on an annual basis before
the end of the state fiscal year (June 30).
9. Effective for state fiscal year 2016 and
forward, the state may elect to use the most recent cost report available as of
June 30 if the audited cost report is more than 2 years old as of June 30 for
the above calculation.
250.624
Non-State Public Hospital
Inpatient Adjustment
All Arkansas non-state government-owned or operated acute care
and critical access hospitals (that is, all acute care and critical access
government hospitals within the state of Arkansas that are neither owned nor
operated by the state of Arkansas) shall qualify for a public hospital
inpatient rate adjustment.
A. The
adjustment shall result in total payments to each hospital that are equal to
but not in excess of the individual facility's Medicare-related upper payment
limit, as prescribed in
42 CFR
§
447.272. The adjustment shall be
calculated as follows.
1. Using data from the
hospital's most recent audited cost report, Arkansas Medicaid shall determine
each eligible non-state public hospital's base Medicare per discharge rate and
its base Medicaid per discharge rate a. Base Medicare and Medicaid per
discharge rates will include respective Case Mix Index (CMI) adjustments in
order to neutralize the impact of the differential between Medicare and
Medicaid case mixes.
b. Arkansas Medicaid will
use the date of the Medicaid Notice of Provider Reimbursement (NPR) received by
the Division of Medical Services from the Medicare Intermediary to determine
the most recent audited cost report period for rate adjustment
purposes.
c. The most current
audited cost report period is used when an earlier period's NPR is finalized
after a later period's.
d. In order
to be used to calculate the rate adjustment amount, the Medicaid NPR received
from the Medicare Intermediary must be dated before July 1 of the state fiscal
year (SFY) for which the adjustment payments will be made.
2. If an ownership change occurs, the
previous owner's audited fiscal periods will be used when audited cost report
information is not available for the current owner.
3. For a hospital that, for the most recent
audited cost report year filed a partial year cost report, such partial year
cost report data shall be annualized to determine the hospital's rate
adjustment; provided that such hospital was licensed and providing services
throughout the entire cost report year.
4. Hospitals with partial year cost reports
which were not licensed and providing services throughout the entire cost
report year shall receive pro-rated adjustments based on the partial year
data.
B. The base
Medicare per discharge rate shall be multiplied by the applicable upper payment
limit (percentage) specified in
42 CFR
§
447.272 for non-state government owned
or operated hospitals.
1. For example, to the
extent that such federal regulation permits Medicaid payments up to 150 percent
of the amount that would be paid under Medicare reimbursement principles, the
base Medicare per discharge rate shall be multiplied by 150 percent.
2. The result shall be the adjusted Medicare
per discharge rate.
3. The base
Medicaid per discharge rate shall then be subtracted from the adjusted Medicare
per discharge rate.
4. The
difference shall be multiplied by the number of Medicaid discharges at the
hospital for the most recent audited fiscal year. The result shall be the
amount of the annual Non-State Public Hospital Adjustment.
C. Payment shall be made on a quarterly basis
within 15 days after the end of the quarter for the previous quarter.
D. Effective for state fiscal year 2016 and
forward, the state may elect to use the most recent cost report available as of
June 30 if the audited cost report is more than 2 years old as of June 30 for
the above calculation.
250.625
Inpatient Adjustment for
Non-State Public Hospitals Outside Arkansas
Effective April 1, 2006 through December 31, 2006, Arkansas may
provide a public inpatient rate adjustment to non-state government owned or
operated acute care regional medical center hospitals located outside of
Arkansas (that is, acute care hospitals outside of Arkansas that are neither
owned nor operated by any state) that:
a) Provide level 1 trauma and burn care
services; b) Provide level 3 neonatal care services; c) Are obligated to serve
all patients, regardless of the patient's state of origin; d) Are located
within a Standard Metropolitan Statistical Area (SMSA) that includes at least 3
states, including Arkansas; e) Serve as a tertiary care provider for patients
residing within a 125 mile radius; and f) Meet the criteria for
disproportionate share hospital under Section 1923 of the Social Security Act
in at least one state other than the state in which the hospital is located.
The adjustment shall result in total payments to each hospital
that are equal to but not in excess of the individual facility's
Medicare-related upper payment limit, as prescribed in
42 CFR
§
447.272. The adjustment shall be
calculated as follows.
A. Using data
from the hospital's most recent audited cost report, Arkansas Medicaid shall
determine each eligible non-state public hospital's base Medicare per discharge
rate and its base Medicaid per discharge rate
1. Base Medicare and Medicaid per discharge
rates will include respective Case Mix Index (CMI) adjustments in order to
neutralize the impact of the differential between Medicare and Medicaid case
mixes.
2. Arkansas Medicaid will
use the date of the Medicaid Notice of Provider Reimbursement (NPR) received by
the Division of Medical Services from the Medicare Intermediary to determine
the most recent audited cost report period for rate adjustment
purposes.
3. The most current
audited cost report period is used when an earlier period's NPR is finalized
after a later period's.
4. In order
to be used to calculate the rate adjustment amount, the Medicaid NPR received
from the Medicare Intermediary must be dated before July 1 of the state fiscal
year (SFY) for which the adjustment payments will be made.
5. If an ownership change occurs, the
previous owner's audited fiscal periods will be used when audited cost report
information is not available for the current owner.
6. For a hospital that, for the most recent
audited cost report year filed a partial year cost report, such partial year
cost report data shall be annualized to determine the hospital's rate
adjustment; provided that such hospital was licensed and providing services
throughout the entire cost report year.
7. Hospitals with partial year cost reports
which were not licensed and providing services throughout the entire cost
report year shall receive pro-rated adjustments based on the partial year
data.
B. The base
Medicare per discharge rate shall be multiplied by the applicable upper payment
limit (percentage) specified in
42 CFR
§
447.272 for non-state government owned
or operated hospitals.
1. For example, to the
extent that such federal regulation permits Medicaid payments up to 150 percent
of the amount that would be paid under Medicare reimbursement principles, the
base Medicare per discharge rate shall be multiplied by 150 percent.
2. The result shall be the adjusted Medicare
per discharge rate.
3. The base
Medicaid per discharge rate shall then be subtracted from the adjusted Medicare
per discharge rate.
4. The
difference shall be multiplied by the number of Medicaid discharges at the
hospital for the most recent audited fiscal year. The result shall be the
amount of the annual Non-State Public Hospital Adjustment.
C. Payment shall be made on a quarterly basis
within 15 days after the end of the quarter for the previous quarter.
D. Effective for state fiscal year 2016 and
forward, the state may elect to use the most recent cost report available as of
June 30 if the audited cost report is more than 2 years old as of June 30 for
the above calculation.
250.626
In-State Private Pediatric
Inpatient Adjustment
All Arkansas private pediatric hospitals qualify for a
pediatric hospital inpatient rate adjustment. The amount of the adjustment
shall be determined annually by Arkansas Medicaid based on available funding.
Each qualifying hospital's adjustment amount shall be equal to their pro rata
share of the total adjustment based on the hospital's Medicaid discharges for
the most recent audited final year. In no case shall the pediatric hospital
adjustment be in an amount that results in aggregate Medicaid inpatient
payments to all private hospitals (including the private hospital inpatient
rate adjustment) that are in excess of the applicable Medicare-related upper
payment limit specified in 42 C.F.R § 447.727.
If an ownership change occurs, the previous owner's audited
fiscal periods will be used when audited cost report information is not
available for the current owner.
Effective for state fiscal year 2016 and forward, the state may
elect to use the most recent cost report available as of June 30 if the audited
cost report is more than 2 years old as of June 30 for the above
calculation.
250.627
Non-State Government Owned or Operated Outpatient UPL Reimbursement
Adjustment
Arkansas non-state government-owned or operated acute
care/general hospitals (that is, all acute care government hospitals within the
state of Arkansas that are neither owned nor operated by the State of Arkansas)
shall qualify for an annual upper payment limit (UPL) reimbursement adjustment.
Psychiatric hospitals, pediatric hospitals, rehabilitative hospitals and
critical access hospitals are not eligible for an adjustment. Payment shall be
made before the end of the state fiscal year (SFY). The adjustment will be
calculated and based on each hospital's previous SFY outpatient
Medicare-related upper payment limit (UPL as specified in
42
CFR 447.321) for Medicaid reimbursed
outpatient services. The adjustments will be calculated as follows:
A. For each qualifying hospital, Arkansas
Medicaid will annually identify the total Medicaid outpatient expenditures
during the most recent completed SFY.
B. For each qualifying hospital, the total
Medicaid expenditures are determined in step A, and are divided by 80% to
estimate the amount that would have been paid using Medicare reimbursement
principles.
C. The difference
between step A identified Medicaid expenditures and step B estimated Medicare
amounts is the UPL annual adjustment amount that will be reimbursed.
Eligible hospitals that were not licensed and providing
services throughout the most recent completed SFY shall receive a pro-rated
adjustment based on the partial year data.
D. Payment for SH+FY 2003 shall be pro-rated
proportional to the number of days between April 1, 2003 and June 30, 2003 to
the total number of days in SFY 2003.
E. If an ownership change occurs, the
previous owner's audited fiscal periods will be used when audited cost report
information is not available for the current owner.
F. Effective for state fiscal year 2016 and
forward, the state may elect to use the most recent cost report available as of
June 30 if the audited cost report is more than 2 years old as of June 30 for
the above calculation.
250.628
Inpatient Hospital Access
Payments
All Arkansas private hospitals (that is, all hospitals within
the state of Arkansas that are neither owned nor operated by state or local
government), with the exception of private rehabilitative and specialty
hospitals, qualify for a private hospital inpatient access payment.
The inpatient access payment shall be equal to each eligible
hospital's pro rata share of a funding pool, based on the hospital's Medicaid
discharges. The amount of the funding pool shall be determined annually by
Arkansas Medicaid based on available funding.
The access payments shall be calculated as follows:
A. Arkansas Medicaid shall annually determine
the amount of available funding for the private hospital access payment funding
pool. The maximum allowable aggregate Medicaid inpatient hospital access
payment for private hospitals will not exceed 97% of the difference between the
Medicaid UPL and the Medicaid-based payments.
B. For each private hospital eligible for the
access payment, Arkansas Medicaid shall determine the number of Medicaid
discharges for the most recent audited fiscal period.
1. Arkansas Medicaid will use the date of the
Medicaid Notice of Provider Reimbursement (NPR) received by the Division of
Medical Services from the Medicare Intermediary to determine the most recent
audited cost report period.
2. The
most current audited cost report period is used when an earlier period's NPR is
finalized after a later period's.
3. In order to be used to calculate the
access payments, the Medicaid NPR received from the Medicare Intermediary must
be dated before July 1 of the state fiscal year (SFY) for which the payments
will be made.
4. If an ownership
change occurs, the previous owner's audited fiscal periods will be used when
audited cost report information is not available for the current
owner.
5. For hospitals that filed
a partial year cost report for the most recently audited cost report year, such
partial year cost report data shall be annualized to determine their access
payment, provided that such hospital was licensed and providing services
throughout the entire cost report year. Hospitals with partial year cost
reports that were not licensed and providing services throughout the entire
cost report year shall receive pro-rated payments based on the partial year
data.
C. To the extent
that this private hospital access payment results in payments in excess of the
upper payment limit, such payments shall be reduced on a pro rata basis
according to each hospital's Medicaid discharges. Such reduction shall be no
more than the amount necessary to ensure that aggregate Medicaid inpatient
reimbursement to private hospitals is equal to but not in excess of the upper
payment limit.
D. For each eligible
private hospital, Arkansas Medicaid shall determine its pro rata percentage,
which shall be a fraction equal to the number of the hospital's Medicaid
discharges divided by the total number of Medicaid discharges of all eligible
hospitals.
E. The amount of each
eligible hospital's access payment shall be its pro rata percentage multiplied
by the amount of available funding for the inpatient hospital access payment
pool as determined by Arkansas Medicaid.
F. Inpatient hospital access payments shall
be made on a quarterly basis.
G.
Effective for state fiscal year 2016 and forward, the state may elect to use
the most recent cost report available as of June 30 if the audited cost report
is more than 2 years old as of June 30 for the above calculation.
250.629
Outpatient Hospital
Access Payments
All Arkansas private hospitals (that is, all hospitals within
the state of Arkansas that are neither owned nor operated by state or local
government), with the exception of private rehabilitative and specialty
hospitals, qualify for a private hospital outpatient access payment.
The outpatient access payment shall be equal to each eligible
hospital's share of a funding pool, pro-rated based on the hospital's paid
claims adjudicated for outpatient hospital services. The amount of the funding
pool shall be determined annually by Arkansas Medicaid based on available
funding.
The access payments shall be calculated as follows:
A. Arkansas Medicaid shall annually determine
the amount of available funding for the private hospital access payment funding
pool by using the Medicare cost principles consistent with the upper payment
limit (UPL) requirements set forth in
42
CFR 447.321. The maximum allowable aggregate
Medicaid outpatient hospital access payment for private hospitals shall not
exceed the difference between the results of Medicaid-based payments and the
Medicaid outpatient hospital services cost.
B. For each private hospital eligible for the
adjustment, Arkansas Medicaid shall determine the Medicaid paid claims
adjudicated for outpatient hospital services for the most recent audited fiscal
period.
1. Arkansas Medicaid will use the date
of the Medicaid Notice of Provider Reimbursement (NPR) received by the Division
of Medical Services from the Medicare Intermediary to determine the most recent
audited cost report period for access payment purposes.
2. The most current audited cost report
period is used when an earlier period's NPR is finalized after a later
period's.
3. In order to be used to
calculate the access payment amount, the Medicaid NPR received from the
Medicare Intermediary must be dated before July 1st of the state fiscal year
(SFY) for which the payments will be made.
4. If an ownership change occurs, the
previous owner's audited fiscal periods will be used when audited cost report
information is not available for the current owner.
5. For hospitals that filed a partial year
cost report for the most recently audited cost report year, such partial year
cost report data shall be annualized to determine their access payments,
provided that such hospitals were licensed and providing services throughout
the entire cost report year. Hospitals with partial year cost reports that were
not licensed and providing services throughout the entire cost report year
shall receive pro-rated access payments based on the partial year
data.
C. For each
eligible private hospital, Arkansas Medicaid shall determine its pro rata
percentage, which shall be a fraction equal to the hospital's Medicaid paid
claims adjudicated for outpatient hospital services divided by the total
Medicaid paid claims adjudicated for outpatient hospital services of all
eligible hospitals.
D. Outpatient
hospital access payments shall be paid on a quarterly basis.
E. Effective for state fiscal year 2016 and
forward, the state may elect to use the most recent cost report available as of
June 30 if the audited cost report is more than 2 years old as of June 30 for
the above calculation.
