Current through all regulations passed and filed through September 16, 2024
This rule is applicable for each program year for all
medicaid-participating psychiatric hospitals as described in paragraphs (B) to
(D) of rule
5160-2-01 of the Administrative
Code.
(A) Definitions for each
psychiatric hospital.
(1) "Cash subsidies for
inpatient services received directly from state and local governments" is the
amount of cash subsidies each psychiatric hospital has received from state and
local governments for inpatient services for the applicable state fiscal year.
In accordance with paragraph (C) of this rule, each psychiatric hospital
reports cash subsidies received from state and local government on "Ohio
Medicaid Hospital Cost Report" ODM 02930, for the applicable state fiscal year,
schedule F, section II, column 4.
(2) "Charges for charity care" is the total
charges for inpatient services provided to indigent patients, which includes
charges for services provided to individuals who do not possess health
insurance for the service provided. Charity care does not include bad debts,
contractual allowances, or uncompensated care costs rendered to patients with
insurance as described in paragraph (A)(13) of this rule. Each psychiatric
hospital reports charges for charity care on ODM 02930, schedule F, section II,
column 3.
(3) "Inpatient days" is
the sum of the number of inpatient fee for service (FFS) hospital days as
reported on ODM 02930, schedule C, section I, column 4 and the number of
inpatient managed care plan (MCP) hospital days as reported on ODM 02930,
schedule C, section III, column 2.
(4) "Insurance revenues" are the revenues
received in the same twelve months of the hospital's cost-reporting period for
inpatient services provided to, billed to, and received from all sources other
than medicaid or self-pay revenues as described in paragraph (A)(6) of this
rule. Each psychiatric hospital reports insurance revenues on ODM 02930,
schedule F, section II, column 1.
(5) "Medicaid inpatient utilization rate" is
the ratio of the psychiatric hospital's number of inpatient days attributable
to patients who were medicaid eligible as described in paragraph (A)(10) of
this rule divided by the psychiatric hospital's total number of inpatient days
as described in paragraph (A)(3) of this rule.
(6) "Self-pay revenues" are the revenues
received in the same twelve months of the hospital's cost-reporting period for
inpatient services provided to, billed to, and received from either the person
that received inpatient services or the family of the person that received
inpatient services. Each psychiatric hospital reports self-pay revenues on ODM
02930, schedule F, section II, column 2.
(7) "Total charges for inpatient services"
for each psychiatric hospital, except for free-standing, state-owned
psychiatric hospitals, is the sum of the amounts reported for inpatient
hospital services on ODM 02930, schedule B, column 6. For free-standing,
state-owned psychiatric hospitals, "total charges for inpatient services"
equals "total inpatient allowable costs" as defined in paragraph (A)(9) of this
rule.
(8) "Total facility inpatient
revenues" is the sum of the hospital's insurance revenues as described in
paragraph (A)(4) of this rule, self-pay revenues as described in paragraph
(A)(6) of this rule, and total medicaid revenues as described in paragraph
(A)(11) of this rule.
(9) "Total
inpatient allowable costs" is the sum of the general service and capital
related costs for inpatient hospital services. Each psychiatric hospital
reports total inpatient allowable costs on ODM 02930 schedule B, column
7.
(10) "Total medicaid days" is
the sum of the amounts that each psychiatric hospital reports on ODM 02930,
schedule F, section II, columns 6 to 8.
(11) "Total medicaid revenues" are the
revenues received in the same twelve months of the hospital's cost-reporting
period for inpatient services provided to, billed to, and received from all
sources other than insurance revenues as described in paragraph (A)(4) of this
rule or self-pay revenues as described in paragraph (A)(6) of this rule. Each
psychiatric hospital reports total FFS medicaid revenues on ODM 02930, schedule
H, section I, column 1 and total MCP medicaid revenues on ODM 02930, schedule
I, column 2.
(12) "Uncompensated
care costs" is the amount calculated by subtracting the sum of the total
facility inpatient revenue as described in paragraph (A)(8) of this rule and
the uncompensated care costs rendered to patients with insurance as described
in paragraph (A)(13) of this rule from the total inpatient allowable costs as
described in paragraph (A)(9) of this rule. For hospitals with negative
uncompensated care costs, the result is equal to zero.
(13) "Uncompensated care costs rendered to
patients with insurance" is the costs for an individual that has insurance
coverage for the service provided, but the full cost of the service was not
reimbursed because of per diem caps or coverage limitations. Each psychiatric
hospital reports uncompensated care costs rendered to patients with insurance
on ODM 02930, schedule F, section II, column 5.
(B) Applicability.
The requirements of this rule are limited pursuant to section
1923 of the Social Security Act,
42 USC
1396r-4 (effective October, 11, 2020).
(C) Source data for calculations.
The calculations described in this rule will be based on
cost-reporting data described in paragraph (B)(1) of rule
5160-2-08 of the Administrative
Code.
(D) Determination of
disproportionate share qualifications for psychiatric hospitals.
Psychiatric hospitals will be determined to be disproportionate
share if based on data described in paragraph (C) of this rule, they meet the
obstetric services requirements as described in paragraph (A)(33) of rule
5160-2-09 of the Administrative
Code, and they meet both qualifications described in paragraphs (D)(1) and
(D)(2) of this rule.
(1) The
hospital's medicaid inpatient utilization rate, as described in paragraph
(A)(5) of this rule, is greater than or equal to one per cent; and
(2) The hospital's uncompensated care costs,
as described in paragraph (A)(12) of this rule is at least
sixty per cent of the hospital's total inpatient
allowable costs as described in paragraph (A)(9) of this rule.
(E) Distribution of funds.
The funds available to each psychiatric hospital qualifying as
a disproportionate share hospital as described in paragraph (D) of this rule
are distributed among the hospitals based on data described in paragraph (C) of
this rule and according to the payment formulas as follows:
(1) For each hospital, calculate the
uncompensated care costs as described in paragraph (A)(12) of this
rule;
(2) For all hospitals, sum
all hospitals' uncompensated care costs as described in paragraph (A)(12) of
this rule;
(3) For each hospital,
calculate the ratio of the amount described in paragraph (E)(1) of this rule to
the amount described in paragraph (E)(2) of this rule;
(4) Multiply the ratio for each hospital
calculated in paragraph (E)(3) of this rule by the disproportionate share funds
available to psychiatric hospitals as described in paragraph (G) of this rule
to determine each hospital's disproportionate share payment amount.
(5) Each hospital will be distributed a
payment amount based on the lesser of;
(a)
Uncompensated care costs as determined in paragraph (A)(12) of this rule;
or
(b) The hospital's
disproportionate share payment as determined in paragraph (E)(4) of this
rule.
(F)
Payments.
The department will make payments in accordance with paragraph
(E) of this rule to qualifying hospitals in accordance with paragraph (D) of
this rule.
(G)
Disproportionate share funds.
The maximum amount of disproportionate share funds available
for distribution to psychiatric hospitals will be determined by subtracting the
funds distributed in accordance with rule
5160-2-09 of the Administrative
Code from the state's disproportionate share limit payment allotment determined
by the centers for medicare and medicaid services (CMS) for that program
year.
