Current through Register Vol. 50, No. 6, December 1, 2023
RELATES TO:
KRS
205.565,
205.637,
205.639,
205.640,
216.380,
42 C.F.R. Parts 412, 413,
440.10,
440.140,
447.250-447.280,
42 U.S.C.
1395f(l),
1395ww(d)(5)(f),
1395x(mm),
1396a,
1396b,
1396d,
1396r-4
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
Family Services, Department for Medicaid Services has responsibility to
administer the Medicaid Program.
KRS
205.520(3) authorizes the
cabinet, by administrative regulation, to comply with a requirement that may be
imposed, or opportunity presented, by federal law for the provision of medical
assistance to Kentucky's indigent citizenry. This administrative regulation
establishes disproportionate share hospital fund distribution provisions in
accordance with
KRS
205.639,
205.640,
205.6401,
and
205.6403.
Section 1. Definitions.
(1) "Base year" means the year of historical
Medicaid DSH survey data used to determine initial DSH payments.
(2) "Department" is defined by
KRS
205.639(4).
(3) "Disproportionate share hospital" or
"DSH" means an in-state hospital that:
(a)
Has a Medicaid inpatient utilization rate of one (1) percent or higher;
and
(b) Meets the criteria
established in
42 U.S.C.
1396r-4(d).
(4) "Final disproportionate share hospital
payment" or "final DSH payment" is defined by
KRS
205.639(6).
(5) "Hospital-specific disproportionate share
hospital limit" or "hospital-specific DSH limit" is defined by
KRS
205.639(7).
(6) "Initial disproportionate share hospital
payment" or "initial DSH payment" is defined by
KRS
205.639(8).
(7) "Medicaid disproportionate share hospital
survey" or "Medicaid DSH survey" is defined by
KRS
205.639(12), and may include
an attestation by a hospital that information has not changed from the
submission of an original Medicaid DSH survey.
(8) "Medicaid inpatient utilization rate" or
"MIUR" is defined by
KRS
205.639(14).
(9) "Total uncompensated care costs" is
defined by
KRS
205.639(19).
Section 2. Disproportionate Share
Hospital Distribution General Provisions.
(1)
Beginning with the state fiscal year 2019 DSH payment, each DSH payment shall
be made in accordance with
KRS
205.639,
205.640,
205.6401,
and
205.6403.
(2) During the determination of an initial
DSH payment, the department may adjust a hospital's total uncompensated care
costs reported on the hospital's base year Medicaid DSH survey if the amount
reported appears likely to result in a substantial redistribution of DSH funds
that could have been avoided by adjusting the hospital's total uncompensated
care costs.
(3) If an overpayment
has been identified, the hospital has not filed a timely appeal pursuant to
907
KAR 1:671, and repayment was not made by the hospital
on or before January 31, pursuant to
KRS
205.640, the department shall withhold future
payment to the hospital until the department has collected in full the amount
owed by the hospital to the department.
Section 3. Disproportionate Share Hospital
Medicaid DSH Survey Submission Provisions.
(1)
Each Medicaid DSH survey submitted for the purpose of determining initial DSH
payment amounts shall be submitted in accordance with the timeline established
in
KRS
205.640.
(2) Each Medicaid DSH survey and supporting
documentation submitted pursuant to subsection (1) of this section shall be
updated prior to the start of the final DSH examination to incorporate more
complete data.
(a) The updated Medicaid DSH
survey and the accompanying supporting documentation shall be submitted no
later than October 31 of the calendar year ending two (2) calendar years after
the end of the state fiscal year to which the DSH payment pertains.
(b) The updated Medicaid DSH survey and the
accompanying supporting documentation shall be submitted even if no changes
were made since the original submission.
(c) A submission of a Medicaid DSH survey by
a hospital shall serve as certification that all Medicaid and uninsured DSH
data is:
1. Complete;
2. Accurate; and
3. In agreement with the hospital's internal
records.
(3)
If a provider does not have twelve (12) months of cost report data needed to
determine an initial DSH payment, the cost report used in determining the
provider's initial DSH payment shall be prioritized as follows:
(a) The most recent cost report, based on the
fiscal year end, in the base year with greater than or equal to six (6) months
of data;
(b) The most recent cost
report, based on the fiscal year end, from the year prior to the base year with
greater than or equal to six (6) months of data; or
(c) If a cost report is not available with at
least six (6) months of data, the new provider proxy method shall be utilized
pursuant to
KRS
205.640(3)(e) 1.d.
Section 4.
Disproportionate Share Hospital Medicaid DSH Payment Appeals Provisions.
(1) An initial DSH payment shall not be
subject to appeal in accordance with
KRS
205.640; and
(2) A final DSH payment shall be subject to
appeal in accordance with
907
KAR 1:671.
Section 5. Disproportionate Share Hospital
Medicaid DSH Survey Payment Redistribution Provisions. For state fiscal year
2011 to state fiscal year 2018, a DSH payment shall be redistributed in
accordance with this section.
(1) A DSH
payment found in the DSH audit process for a given state fiscal year that
exceeds the DSH limit for a hospital shall be recouped from that hospital in
order to reduce the DSH payment to the limit established pursuant to this
administrative regulation.
(a) The excess
amount identified shall be due to the department within sixty (60) days after
notification, unless an appeal is filed in a timely fashion pursuant to
907
KAR 1:671.
(b) If a hospital does not file a timely
appeal pursuant to
907
KAR 1:671 and does not submit the excess amount
established pursuant to this subsection within sixty (60) days, the department
shall withhold future payments to the hospital until the department has
collected in full the amount owed by the hospital to the department.
(2) A payment that is recouped
from a hospital as a result of the DSH audit shall be redistributed to
hospitals that have been determined by the department to have paid less than
their hospital-specific DSH limit pursuant to this administrative
regulation.
(3) Each redistribution
shall:
(a) Occur proportionately to the
original distribution of DSH funds; and
(b) Not exceed each hospital's specific DSH
limit.
(4) If, because
of the hospital-specific DSH limits, DSH funds cannot be fully redistributed
within the original distribution pool established pursuant to subsection (3) of
this section, the excess funds shall be redistributed to the other distribution
pools in proportion to the original DSH payments made by the
department.
(5) If the Medicaid
program's original DSH payments do not fully expend the federal DSH allotment
for any state fiscal year, the remaining DSH allotment shall be:
(a) Retroactively paid to each hospital that
is determined to have received less than its hospital-specific DSH limit after
consideration of any potential redistributions pursuant to subsection (1) of
this section;
(b) Proportional to
the original DSH payment made to each hospital; and
(c) Limited to each hospital's specific DSH
limit.
Section
6. Federal Approval and Federal Financial Participation. The
department's coverage of DSH payments or other services pursuant to this
administrative regulation shall be contingent upon:
(1) Receipt of federal financial
participation;
(2) Availability of
state funds; and
(3) Centers for
Medicare and Medicaid Services' approval.
34 Ky.R. 1610; Am.
2195; 2409; eff. 6-6-2008; Recodified from 907 KAR 1:820; eff. 5-3-2011; 45
Ky.R. 2218, 2930, 3184; eff. 5-31-2019.
STATUTORY AUTHORITY:
KRS
194A.030(2),
194A.050(1),
205.520(3),
205.560(2),
205.637(3),
205.639,
205.640,
205.6401,
205.6403,
216.380(12),
42 C.F.R. Parts 412, 413,
447.252,
447.253, 447,
Subpart E,
42 U.S.C.
1395ww(d)(5)(F),
1396a,
1396r-4
