Current through Register 1531, September 27, 2024
(1)
Payment Eligibility. To be eligible to receive payment
from the Trust Fund, an acute care hospital must be:
(a) licensed under M.G.L. c. 111, § 51,
as defined by the Department of Public Health; and
(b) a hospital with SRP below 120% of the
median SRP, as determined by the Center.
(2)
Payment
Conditions.
(a) As a condition
of receiving payments from the Trust Fund, EOHHS may require an eligible acute
care hospital to provide an attestation, in a format prescribed by EOHHS,
agreeing to an independent financial and operational audit to recommend steps
to increase sustainability and efficiency of the acute care hospital.
(b) EOHHS may also require that eligible
acute care hospitals utilize payments received from the Trust Fund to conduct
the independent financial and operational audit described in 101 CMR
701.04(2)(a) and/or to advance steps recommended in the audit for improving or
continuing health care services that benefit the uninsured, underinsured, and
MassHealth populations.
(c) EOHHS
may, via administrative bulletin or other written issuance,
establish rules governing various conditions of payment, including, but not
limited to, attestations, reporting requirements, compliance with payment
conditions, penalties for noncompliance, and recovery.
(3)
Timing of
Payments. EOHHS will direct payments to eligible acute care
hospitals from the Trust Fund each state fiscal year in which funding is
available in the Trust Fund, and may make such payments in
installments.
(4)
Payment Methodology.
(a)
Data Source.
1.
Determination of
GPSR. GPSR is determined using Hospital Cost Reports submitted to
the Center pursuant to
957 CMR 9.00: Hospital
Financial Data Reporting Requirements.
2.
Determination of
SRP. SRP is determined using data submitted to the Center pursuant
to
957 CMR
2.00: Payer Data Reporting.
(b)
Calculation of
Median SRP. The Center will calculate annually a median SRP and
identify acute care hospitals with SRP below 120% of the median SRP.
(c)
Payment
Allocation.
1. EOHHS will
allocate payments to eligible acute care hospitals based on:
a. the proportion of each eligible acute care
hospital's GPSR to the combined GPSR of all eligible acute care hospitals;
and
b. The distance of each
eligible acute care hospital's SRP from 120 % of the median SRP such that
eligible Acute Care Hospitals with SRP that fall further below 120 % of the
median SRP receive proportionally greater payments.
2. Calculation of payments for eligible acute
care hospitals.
a. Calculate a
hospital-specific GPSR weight, which is equal to 100 % plus the hospital's
percent of the combined GPSR of all eligible hospitals, using the following
formula:
[Hospitaln GPSR weight = 100% +
(Hospitaln GPSR / [SIGMA] All hospitals GPSR)]
b. Calculate a hospital-specific
SRP weight, which is equal to the difference between the hospital's SRP and 120
% of the median SRP, divided by the hospital's SRP, using the following
formula:
[Hospitaln SRP weight = (120% of the
median SRP - Hospitaln SRP) /
Hospitaln SRP]
Example: A hospital-specific SRP
weight of 1.0 corresponds to a hospital with an SRP that is 60 % of the median
SRP; that is:
[(120 % of the median SRP) - (60% of the median SRP)] / (60% of
the median SRP) = 1.0
3. For each hospital, a total weight is
calculated by multiplying the hospital-specific GPSR weight calculated in 101
CMR 701.04(4)(c)2.a. by the hospital-specific SRP weight calculated in 101 CMR
701.04(4)(c)2.b., according to the following formula:
[Total weight for Hospitaln = Hospitaln
GPSR weight * Hospitaln SRP weight]
4. For each hospital, a normalized total
weight is calculated by dividing the hospital-specific total weight described
in 101 CMR 701.04(4)(c)3. by the combined total weight of all eligible acute
care hospitals according to the following formula:
[Normalized total weight for Hospitaln =
Hospitaln total weight / [SIGMA]Total weight of all hospitals]
5. The potential payment for each
hospital is calculated by multiplying the total funding available from the
Trust Fund in a state fiscal year by the hospital's normalized total weight
calculated in 101 CMR 701.04(4)(c)4., according to the following formula:
[Potential Payment for Hospitaln = Total
funding available from the Trust Fund in a state fiscal year *
Hospitaln normalized total weight]
