Current through Register Vol. 41, No. 3, September 23, 2024
A. In
addition to payments made elsewhere, effective July 1, 2005, DMAS shall draw
down federal funds to cover unreimbursed Medicaid costs for inpatient services
provided by non-state-government-owned hospitals as certified by the provider
through cost reports.
B. A
non-state-government-owned hospital is owned or operated by a unit of
government other than a state.
C.
Effective July 1, 2018, additional supplemental payments will be issued to each
non-state-government-owned acute care hospital for inpatient services provided
to Medicaid patients.
1. The supplemental
payment shall equal inpatient hospital clam payments times the upper payment
limit (UPL) gap percentage.
a. The annual UPL
gap percentage is the percentage calculated where the numerator is the
difference for each non-state-government-owned acute care hospital between a
reasonable estimate of the amount that would be paid under Medicare payment
principles for inpatient hospital services provided to Medicaid patients, as
calculated in accordance with
42
CFR 447.272, and what Medicaid paid for such
services, and the denominator is Medicaid claim payments to each hospital for
inpatient hospital services provided to Medicaid patients in the same years
used in the numerator.
b. The UPL
gap percentage will be calculated annually for each hospital using data for the
most recent year for which comprehensive annual data are available and inflated
to the state fiscal year for which payments are to be made.
c. Maximum aggregate payments to all
qualifying hospitals shall not exceed the available upper payment limit. If
inpatient payments for non-state-government-owned hospitals would exceed the
upper payment limit, the numerator in the calculation of the UPL gap percentage
shall be reduced proportionately.
2. After the close of each quarter, beginning
with the July 1, 2018, to September 30, 2018, quarter, each qualifying hospital
shall receive supplemental payments for the inpatient services paid during the
prior quarter. The supplemental payments for each qualifying hospital for each
quarter shall be calculated by multiplying the Medicaid inpatient hospital
payments paid in that quarter by the annual UPL gap percentage for each
hospital.
Statutory Authority: §
32.1-325
of the Code of Virginia;
42 USC §
1396 et
seq.
