ARTICLE 19 SUBSTITUTE A
RELATING TO HOSPITAL UNCOMPENSATED CARE
SECTION 1. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter
40-8.3 entitled “Uncompensated Care” are hereby amended to read as follows:
40-8.3-2. Definitions. – As
used in this chapter:
(1) "Base
year" means for the purpose of calculating a disproportionate share payment
for any fiscal year ending after September 30, 2005, the period from October 1,
2003 through September 30, 2004 and for any fiscal year ending after
September 30, 2007, the period from October 1, 2005 through September 30, 2006.
(2) "Medical assistance
inpatient utilization rate for a hospital" means a fraction (expressed as
a percentage) the numerator of which is the hospital's number of inpatient days
during the base year attributable to patients who were eligible for medical
assistance during the base year and the denominator of which is the total
number of the hospital's inpatient days in the base year.
(3) "Participating
hospital" means any nongovernment and nonpsychiatric hospital that: (i)
was licensed as a hospital in accordance with chapter 17 of title 23 during the
base year, (ii) achieved a medical assistance inpatient utilization rate of at
least one percent (1%) during the base year, and (iii) continues to be licensed
as a hospital in accordance with chapter 17 of title 23 during the payment
year.
(4) "Uncompensated
care costs" means, as to any hospital, the sum of: (i) the cost incurred
by such hospital during the base year for inpatient or outpatient services
attributable to charity care (free care and bad debts) for which the patient
has no health insurance or other third-party coverage less payments, if any,
received directly from such patients and (ii) the cost incurred by such
hospital during the base year for inpatient or out-patient services
attributable to medicaid beneficiaries less any medicaid reimbursement received
therefor; multiplied by the uncompensated care index.
(5) "Uncompensated
care index" means the annual percentage increase for hospitals established
pursuant to § 27-19-14 for each year after the base year, up to and including
the payment year, provided, however, that the uncompensated care index for the
payment year ending September 30, 2005 shall be deemed to be five and
eighty-five hundredths percent (5.85%), and that the uncompensated care index
for the payment year ending September 30, 2006 shall be deemed to be five and
fifty hundredths percent (5.50%), and that the uncompensated care index for the
payment year ending September 30, 2007 shall be deemed to be five and
forty-seven hundredths percent (5.47%), and that the uncompensated care
index for the payment year ending September 30, 2008 shall be deemed to be five
and forty seven hundredths percent (5.47%).
40-8.3-3. Implementation. – (a)
For the fiscal year commencing on October 1, 2006 and ending September 30,
2007, the department of human services shall submit to the Secretary of the
U.S. Department of Health and Human Services a state plan amendment to the
Rhode Island Medicaid state plan for disproportionate share hospital payments
(DSH Plan) to provide:
(1) Disproportionate share
hospital payments to all participating hospitals not to exceed an aggregate
limit of $97.8 million, to be allocated by the department to the Pool A, Pool C
and Pool D components of the DSH Plan;
(2) That the Pool D allotment
shall be distributed among the participating hospitals in direct proportion to
the individual participating hospitals uncompensated care costs for the base
year inflated by the uncompensated care index to the total uncompensated care
costs for the base year inflated by uncompensated care index for all
participating hospitals. The disproportionate share payments shall be made on
or before July 16, 2007 and are expressly conditioned upon approval on or
before July 9, 2007 the Secretary of the U.S. Department of Health and Human
Services, or his or her authorized representative, of all Medicaid state plan
amendments necessary to secure for the state the benefit of federal financial
participation in federal fiscal year 2007 8 for the
disproportionate share payments.
(b) For the fiscal year
commencing on October 1, 2007 and ending September 30, 2008, the department of
human services shall submit to the Secretary of the U.S. Department of Health
and Human Services a state plan amendment to the Rhode Island Medicaid state
plan for disproportionate share hospital payments (DSH Plan) to provide:
(1) Disproportionate share
hospital payments to all participating hospitals not to exceed an aggregate
limit of $99.5 million, to be allocated by the department to the Pool A, Pool C
and Pool D components of the DSH Plan;
(2) That the Pool D allotment
shall be distributed among the participating hospitals in direct proportion to
the individual participating hospitals uncompensated care costs for the base
year inflated by the uncompensated care index to the total uncompensated care
costs for the base year inflated by uncompensated care index for all
participating hospitals. The disproportionate share payments shall be made on
or before July 14, 2008 and are expressly conditioned upon approval on or
before July 7, 2008 the Secretary of the U.S. Department of Health and Human
Services, or his or her authorized representative, of all Medicaid state plan
amendments necessary to secure for the state the benefit of federal financial
participation in federal fiscal year 2008 for the disproportionate share
payments.
(b) (c) No provision is made pursuant to this
chapter for disproportionate share hospital payments to participating hospitals
for uncompensated care costs related to graduate medical education programs.
SECTION 2. This article shall
take effect upon passage.