ABSTRACT
This final rule addresses the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments under section 1923(g)(1)(A) of the Social Security Act (Act), and the application of such limitation in the annual DSH audits required under section 1923(j) of the Act, by clarifying that the hospital-specific DSH limit is based only on uncompensated care costs. Specifically, this rule makes explicit in the text of the regulation, an existing interpretation that uncompensated care costs include only those costs for Medicaid eligible individuals that remain after accounting for payments made to hospitals by or on behalf of Medicaid eligible individuals, including Medicare and other third party payments that compensate the hospitals for care furnished to such individuals. As a result, the hospital-specific limit calculation will reflect only the costs for Medicaid eligible individuals for which the hospital has not received payment from any source.
Subject(s)
Economics, Hospital/legislation & jurisprudence , Medicaid/economics , Medicaid/legislation & jurisprudence , Reimbursement, Disproportionate Share/economics , Reimbursement, Disproportionate Share/legislation & jurisprudence , Uncompensated Care/economics , Uncompensated Care/legislation & jurisprudence , Humans , United StatesSubject(s)
Private Practice/legislation & jurisprudence , Private Sector/legislation & jurisprudence , Radiology/economics , Radiology/legislation & jurisprudence , Reimbursement, Disproportionate Share/economics , Reimbursement, Disproportionate Share/legislation & jurisprudence , Germany , Government Regulation , Insurance, Health/economics , Insurance, Health/legislation & jurisprudence , Private Sector/economicsABSTRACT
This final rule addresses the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments under the Social Security Act (the Act). Under this limitation, DSH payments to a hospital cannot exceed the uncompensated costs of furnishing hospital services by the hospital to individuals who are Medicaid-eligible or "have no health insurance (or other source of third party coverage) for the services furnished during the year.'' This rule provides that, in auditing DSH payments, the quoted test will be applied on a service-specific basis; so that the calculation of uncompensated care for purposes of the hospital-specific DSH limit will include the cost of each service furnished to an individual by that hospital for which the individual had no health insurance or other source of third party coverage.
Subject(s)
Economics, Hospital/legislation & jurisprudence , Medicaid/economics , Medically Uninsured/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Humans , Medicaid/legislation & jurisprudence , Prisoners/legislation & jurisprudence , Reimbursement, Disproportionate Share/economics , Uncompensated Care/economics , Uncompensated Care/legislation & jurisprudence , United States , United States Indian Health Service/economics , United States Indian Health Service/legislation & jurisprudenceABSTRACT
Medicare's new disproportionate share hospital (DSH) payment method combines a payment amounting to 25 percent of what a hospital would have traditionally received with an additional amount that is the product of three factors: An estimate of the aggregate amount of DSH payments that the Medicare program would have paid in FFY14 under the traditional payment method. An adjustment to that figure to account for an estimated percentage change in the national uninsured rate between FFY13 and FFY14. Each hospital's estimated percentage of the total uncompensated care costs incurred by all hospitals that are expected to qualify for DSH payments.
Subject(s)
Economics, Hospital/legislation & jurisprudence , Reimbursement, Disproportionate Share/economics , Reimbursement, Disproportionate Share/legislation & jurisprudence , Medicare , United StatesABSTRACT
: In the fiscal year (FY) 2014 inpatient prospective payment systems (IPPS)/long-term care hospital (LTCH) PPS final rule, we established the methodology for determining the amount of uncompensated care payments made to hospitals eligible for the disproportionate share hospital (DSH) payment adjustment in FY 2014 and a process for making interim and final payments. This interim final rule with comment period revises certain operational considerations for hospitals with Medicare cost reporting periods that span more than one Federal fiscal year and also makes changes to the data that will be used in the uncompensated care payment calculation in order to ensure that data from Indian Health Service (IHS) hospitals are included in Factor 1 and Factor 3 of that calculation.
Subject(s)
Economics, Hospital/legislation & jurisprudence , Legislation, Hospital/economics , Medicare/economics , Prospective Payment System/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Uncompensated Care/legislation & jurisprudence , Humans , Inpatients , Medicare/legislation & jurisprudence , Prospective Payment System/economics , Reimbursement, Disproportionate Share/economics , United StatesABSTRACT
The statute, as amended by the Affordable Care Act, requires aggregate reductions to state Medicaid Disproportionate Share Hospital (DSH) allotments annually from fiscal year (FY) 2014 through FY 2020. This final rule delineates a methodology to implement the annual reductions for FY 2014 and FY 2015. The rule also includes additional DSH reporting requirements for use in implementing the DSH health reform methodology.
Subject(s)
Economics, Hospital/legislation & jurisprudence , Legislation, Hospital/economics , Medicaid/legislation & jurisprudence , Reimbursement Mechanisms/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Uncompensated Care/legislation & jurisprudence , Humans , Medicaid/economics , Medically Uninsured/legislation & jurisprudence , Patient Protection and Affordable Care Act , Reimbursement Mechanisms/economics , Reimbursement, Disproportionate Share/economics , Uncompensated Care/economics , United StatesABSTRACT
State Medicaid programs make Medicaid disproportionate share hospital (DSH) payments to hospitals to help offset costs of uncompensated care for Medicaid and uninsured patients. Unlike most Medicaid spending, annual DSH allotments for each state are capped. Under the Patient Protection and Affordable Care Act of 2010 (ACA), DSH payments will decrease starting in fiscal year (FY) 2014 and continuing through FY 2020. This paper describes the proposed rule for reducing these federal allotments, which was released on May 15, 2013, by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due July 12, 2013.
Subject(s)
Centers for Medicare and Medicaid Services, U.S. , Economics, Hospital/legislation & jurisprudence , Medicaid/economics , Patient Protection and Affordable Care Act/economics , Reimbursement, Disproportionate Share/economics , Budgets , Forecasting , Health Expenditures , Humans , Medicaid/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Reimbursement, Disproportionate Share/trends , State Government , Uncompensated Care/economics , Uncompensated Care/legislation & jurisprudence , United StatesSubject(s)
Ambulatory Care Facilities/legislation & jurisprudence , Drug Costs/legislation & jurisprudence , Drug Industry/legislation & jurisprudence , Ambulatory Care Facilities/economics , Cost Savings/legislation & jurisprudence , Cost Savings/methods , Drug Industry/economics , Humans , Reimbursement, Disproportionate Share/legislation & jurisprudence , United States , United States Health Resources and Services Administration , VirginiaABSTRACT
The specific aim of this analysis is to demonstrate how the trade-off between efficiency and equity policy approaches affects the ability of at-risk children to access quality health care services at the King/Drew Medical Center of Los Angeles County from 1980 to 2000. The concept of a second market phenomenon is used as a framework to illustrate how efficiency-seeking behaviors of federal, state, and local government actors affected government intervention efforts initiated to remedy health care access hardships created by market failure in low-income communities. A second market failure occurs when government failure results from the reintroduction of market protocols in an environment where the market had originally failed to facilitate the distribution of basic goods and services. The review suggest that financial austerity at the Los Angeles County Department of Health Services in the context of federal, state, and local government policies that emphasized allocative efficiencies, compromised equity values by undermining access to quality pediatric services at the King/Drew Medical Center which was a municipal academic medical center.
Subject(s)
Academic Medical Centers/economics , Child Health Services/economics , Health Policy/economics , Health Services Accessibility/economics , Quality of Health Care/economics , Academic Medical Centers/legislation & jurisprudence , Academic Medical Centers/organization & administration , California , Child , Child Health Services/legislation & jurisprudence , Cost Control/standards , Economic Competition/standards , Economic Competition/trends , Efficiency, Organizational , Financial Management, Hospital , Financing, Government/standards , Financing, Government/trends , Government Regulation , Health Services Accessibility/legislation & jurisprudence , Humans , Los Angeles , Medicaid , Medically Uninsured/legislation & jurisprudence , Quality of Health Care/legislation & jurisprudence , Reimbursement, Disproportionate Share/economics , Reimbursement, Disproportionate Share/legislation & jurisprudence , United StatesSubject(s)
Emergency Medical Services/trends , Health Services Accessibility/trends , Medically Uninsured , Economics, Hospital , Emergency Medical Services/economics , Emergency Medical Services/legislation & jurisprudence , Health Care Reform , Health Services Accessibility/economics , Health Services Accessibility/legislation & jurisprudence , Humans , Insurance, Health , Medically Uninsured/legislation & jurisprudence , Reimbursement, Disproportionate Share/economics , Reimbursement, Disproportionate Share/legislation & jurisprudence , United States , United States Health Resources and Services AdministrationSubject(s)
Academic Medical Centers/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Health Care Reform/legislation & jurisprudence , Health Facility Merger/history , Health Facility Merger/legislation & jurisprudence , History, 20th Century , Hospitals, Voluntary/legislation & jurisprudence , Humans , Massachusetts , Reimbursement Mechanisms/legislation & jurisprudence , Reimbursement, Disproportionate Share/history , United StatesABSTRACT
Congress and the Obama administration are considering redirecting federal spending on the Medicaid disproportionate-share hospital (DSH) program to help pay for health reform. In this paper, we propose linking federal Medicaid DSH funding to state-level Medicaid enrollment or uninsured populations, or both. This approach could produce as much as $44 billion in federal savings over time without exposing hospitals to uncertain or across-the-board spending cuts. It could also gradually address state variations in Medicaid DSH funding. We also offer ideas to ensure that DSH spending is more directly connected than it is now to improvements in care for vulnerable populations.
Subject(s)
Economics, Hospital , Financing, Government/legislation & jurisprudence , Health Care Reform , Medicaid/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Humans , Insurance Coverage/legislation & jurisprudence , Medically Uninsured/legislation & jurisprudence , State Health Plans/economics , United StatesSubject(s)
Delivery of Health Care/economics , Economics, Hospital , Financing, Government , Reimbursement, Disproportionate Share , Humans , Reimbursement, Disproportionate Share/economics , Reimbursement, Disproportionate Share/legislation & jurisprudence , Reimbursement, Disproportionate Share/statistics & numerical data , State Government , Uncompensated Care , United StatesABSTRACT
El perjuicio estético ha sido tradicionalmente relegado en los baremos de valoración, sin establecer con claridad cuáles eran los elementos a considerar en su valoración y cuantificación. La existencia de factores tanto funcionales, como de alteración de la normal forma, han podido determinar una imprecisa valoración, especialmente plasmada en el baremo al uso más importante en nuestro país: el empleado para la indemnización de lesiones derivadas de los accidentes de tráfico contenido actualmente en el Real Decreto Legislativo 8/2004. Proponemos unos nuevos criterios de valoración que atiendan a todos los aspectos precisos, eliminando el capítulo especial de cuantificación del perjuicio estético e incluyéndolo con el resto de las secuelas cuantificables en los diferentes apartados de la Tabla VI (AU)
The aesthetic damage traditionally has been relegated in the most important scales, and especially in the Spanish origin, at a second level, without clarity establishing with which are the elements to consider in their valuation and quantification. The existence of functional factors, and normal form alteration, has been able to determine a vague valuation, especially shaped in the scale of most important use in our country: this one to indemnification of injuries derived from the road traffic accidents contained into the Royal Legislative Decree 8/2004. We propose new criteria of valuation that take care of all the precise aspects, eliminating the special chapter of quantification of the aesthetic damage and including it with the rest of the quantifiable sequels in the different sections from the Table VI (AU)
Subject(s)
Humans , Male , Female , Esthetics , Damage Assessment/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Plastic Surgery Procedures/ethics , Plastic Surgery Procedures/legislation & jurisprudence , Statistics on Sequelae and DisabilityABSTRACT
This final rule sets forth the data elements necessary to comply with the requirements of Section 1923(j) of the Social Security Act (Act) related to auditing and reporting of disproportionate share hospital payments under State Medicaid programs. These requirements were added by Section 1001(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Subject(s)
Economics, Hospital/legislation & jurisprudence , Medicaid/economics , Reimbursement, Disproportionate Share/economics , Humans , Medicaid/legislation & jurisprudence , Reimbursement, Disproportionate Share/legislation & jurisprudence , Social Security/economics , Social Security/legislation & jurisprudence , State Government , United StatesABSTRACT
Navigating the byzantine rules governing disproportionate-share supplements presents hospitals with a special challenge. But some have discovered a little-known secret: By combining two or more hospitals under a single Medicare provider number, some can increase their level of reimbursement. "We had to do something to stem the losses that were occurring in both institutions at that time," says Bob Reh, left.