Current through Register Vol. 54, No. 38, September 21, 2024
(a) Providers of inpatient hospital services
shall receive an additional payment in recognition of the costs of medical
education as provided pursuant to an approved teaching program and as
reimbursed under the Medicare Program. For providers with an approved teaching
program in place prior to January 1, 1995, the medical education add-on payment
shall be based on the following calculations:
(1) Payments for direct medical education
costs shall be based on figures from the latest audited Medicare cost report
and calculated as follows: the medical education cost (Worksheet E, Part IV,
Column 1, Line 18) shall be divided by total hospital DRG payments (Worksheet
E, Part A, Column 1). This amount shall then be multiplied by the DRG payment
on the date of discharge.
(2)
Payments for indirect medical education costs shall be calculated as follows:
the add-on percentage, identified in the provider's latest Medicare interim
rate notification, multiplied by the DRG payment on the date of
discharge.
(3) Payments for
paramedical education costs shall be calculated by determining the ratio of
Medicare paramedical education costs to Medicare DRG payments. This ratio shall
then be multiplied by the DRG payment on the date of discharge. The necessary
ratio shall be computed as follows:
(i) If the
most recently audited Medicare cost report is for a fiscal year beginning on or
after October 1, 1991, and uses HCFA Form 2552-92, then the ratio shall be
determined by taking the sum of Lines 14 and 15 on Worksheet E, Part A and
dividing it by Line 1.
(ii) If the
most recently audited Medicare cost report is for a fiscal year beginning
before October 1, 1991, and uses HCFA Form 2552-89, then the ratio shall be
determined by taking the sum of medical education costs from Worksheet D, Part
I, Column 5, Line 101 and Worksheet D, Part II, Column 5, Line 101 and dividing
the sum by total charges from Worksheet D, Part II, Column 7, Line 101;
multiplying this amount by Medicare charges from Worksheet D, Part II, Column
9, Line 101; and dividing this amount by DRG payments from Worksheet E, Part A,
Line 1.
(b) If
a hospital loses its right to receive add-on payments for medical education
costs under the Medicare Program, it shall also lose its right to receive the
corresponding add-on payments for medical education costs under the act,
commencing with services rendered on or after January 1 of the year succeeding
the change in status. The hospital shall notify the Bureau in writing of this
change in status on or before November 30 of the year in which the hospital has
lost the right to receive a medical education add-on payment.
(c) On and after January 1, 1995, if a
hospital begins receiving add-on payments for medical education costs under the
Medicare Program, it shall also gain the right to receive add-on payments for
medical education costs under the act, commencing with services rendered on or
after January 1 of the year succeeding the change in status.
(1) The hospital shall notify the Bureau in
writing of this change in status on or before November 30 of the year in which
the hospital has gained the right to receive a medical education add-on
payment. The notification shall include the following:
(i) Documentation that the medical education
costs are incurred as the result of an approved teaching program, as accredited
by the appropriate approving body.
(ii) The notice of per resident amount for
direct medical education.
(iii) The
interim rate notification for indirect medical education.
(iv) The notice of biweekly payment rates
received from the Medicare Intermediary.
(v) A complete copy of the most recently
audited Medicare cost report as of November 30 of the year in which the
hospital gained the right to receive additional payments for medical education
costs.
(2) If the
hospital gained the right to receive a medical education add-on payment on or
after January 1, 1995, the payment shall be based on the following
calculations:
(i) Payments for direct medical
education costs shall be based on the notice of biweekly payment amount. This
amount shall be annualized, multiplied by the ratio of Part A reasonable cost
to total reasonable cost from Worksheet E-3, Part IV, Line 15, and divided by
total hospital DRG payments from the most recently audited Medicare cost report
(Worksheet E, Part A, Column 1, Line 1). This amount shall then be multiplied
by the DRG payment on the date of discharge.
(ii) Payments for indirect medical education
costs shall be calculated as follows: the add-on percentage, identified in the
provider's most recent Medicare interim rate notification for the calendar year
in which the approved teaching program commenced, multiplied by the DRG payment
on the date of discharge.
(iii)
Payments for paramedical education costs shall be based on the notice of
biweekly payment amount. This amount shall be annualized, multiplied by the
ratio of Part A reasonable cost to total reasonable costs from Worksheet E-3,
Part IV, Line 15, and divided by total hospital DRG payments from the most
recently audited Medicare cost report (Worksheet E, Part A, Column 1, Line 1).
This amount shall be multiplied by the DRG payment on the date of
discharge.
This section cited in 34 Pa. Code §
127.101 (relating to medical fee
caps-Medicare); 34 Pa. Code §
127.154 (relating to medical fee
updates on and after January 1, 1995-inpatient acute care providers subject to
DRGs plus add-on payments).
