Current through Register Vol. 51, No. 19, September 20, 2024
A.
Free-Standing Acute General, Chronic, or Pediatric/Rehabilitation Hospitals.
(1) Except as set forth in §A(2) of this
regulation, the disproportionate share payment for disproportionate share
hospitals that are free-standing hospitals licensed as acute general, chronic,
or jointly as pediatric and rehabilitation equals an amount determined in
accordance with 42 CFR
§ 412.106, but only if the hospital
qualifies as a disproportionate share hospital under
42 CFR § 412.106.
(2) Free-standing hospitals that are approved
by the Program for reimbursement according to rates established by the HSCRC
receive a bad debt allowance, which is recognized as a disproportionate share
payment equal to or greater than the amount set forth in §A(1) of this
regulation, and an additional payment may not be made under this
chapter.
B. The
disproportionate share payment rate relating to Program payments on or after
October 1, 1992 for free-standing hospitals licensed exclusively as:
(1) Psychiatric with charity care inpatient
costs:
(a) Exceeding 40 percent of total
inpatient hospital costs equals the greater of the:
(i) Hospital's annual low income costs
divided by its annual inpatient Medicaid costs, minus 1, all multiplied by 2,
and then multiplied by its inpatient Medicaid payment, or
(ii) Minimum payment required by federal
law;
(b) Less than or
equal to 40 percent of total inpatient hospital costs equals the minimum
payment required by federal law;
(2) Rehabilitation with charity care
inpatient costs:
(a) Exceeding 20 percent of
total inpatient hospital costs equals the greater of the:
(i) Hospital's annual low income costs
divided by its annual inpatient Medicaid costs, minus 1, multiplied by its
inpatient Medicaid payment, or
(ii)
Minimum payment required by federal law;
(b) Less than or equal to 20 percent of total
inpatient hospital costs equals the minimum required by federal law.
C. If a hospital
qualifies under both §§A(2) and B of this regulation, it is governed
by §A(2) of this regulation.
D. Payments according to §A or B of this
regulation shall be:
(1) Based on data on
annual low-income hospital costs, annual inpatient Medicaid costs, and data
pertaining to 42 CFR § 412.106 from the complete State fiscal year
occurring 2 years before the fiscal year during which payments are
made;
(2) Made in one or more
payments covering the complete fiscal year; and
(3) Made to appropriate hospital providers
that comply with all regulations set forth in COMAR 10.09.92-10.09.95.
E. Out-of-State
hospitals determined by the host state Medicaid Program to be a
disproportionate share hospital shall be paid a disproportionate share
adjustment as determined by the host state Medicaid Program, with a hospital's
total adjustment not to exceed 1 percent of the total Maryland Medical
Assistance payments to that hospital in a fiscal year.
F. Qualification Requirements.
(1) Except as set forth in §F(2) of this
regulation, to qualify as a disproportionate share hospital, a hospital shall
supply to the Program, 6 months before the start of the applicable fiscal year:
(a) Information necessary to determine if the
hospital qualifies as a disproportionate share hospital; and
(b) Data required under §D(1) of this
regulation.
(2) For
payments in fiscal year 93, the information required in this section shall be
presented to the Department within 10 days of the effective date of these
regulations.
G. A
free-standing hospital licensed exclusively as psychiatric or rehabilitation
for at least 2 years, that has not been a Maryland Medicaid provider for at
least 2 years, shall receive a disproportionate share payment, for any year,
not greater than the hospital's low-income hospital costs in the complete State
fiscal year occurring 2 years before the fiscal year during which payments are
made.
H. If it is determined that a
payment made to any hospital under this regulation exceeds the actual amount of
uncompensated care and would result in reverting funds to CMS, the overpayment
shall be used for another provider that received less than that provider was
eligible to receive. The redistribution shall be available to all providers
that are eligible for disproportionate share payments except those whose rates
are set by HSCRC.