KRS § 205.639 — KY Code / Title XVII / Chapter 205 / Section 205.639
205.639 Definitions for KRS 205.639 to 205.640
Status: in_force

205.639 Definitions for KRS 205.639 to 205.640.

As used in KRS 205.639 to 205.640, unless the context otherwise requires:

(1) "Acute care hospital" means an acute care hospital licensed under KRS 216B.0425

except that it shall not include a critical access hospital, private psychiatric hospital,

or state mental hospital;

(2) "Comprehensive physical rehabilitation hospital" means an in-state freestanding

rehabilitation hospital that also meets the criteria for an inpatient rehabilitation

facility under 42 C.F.R. sec. 412.29;

(3) "Critical access hospital" means a hospital licensed as a critical access hospital

under KRS 216.380;

(4) "Department" means the Department for Medicaid Services;

(5) "Essential hospital" means an acute care hospital that qualifies as a Medicaid

inpatient utilization rate (MIUR) hospital, a low-income utilization rate (LIUR)

hospital, or a critical access hospital;

(6) "Final disproportionate share hospital payment" or "final DSH payment" means the

state fiscal year DSH payment for a hospital determined by the department using the

hospital's examined Medicaid DSH survey and which is reconciled to the hospital's

initial state fiscal year DSH payment and limited to the hospital's hospital-specific

DSH limit;

(7) "Hospital-specific disproportionate share hospital limit" or "Hospital-specific DSH

limit" means the limitation required under 42 U.S.C. sec. 1396r-4(g) and

corresponding regulations that a DSH payment may not exceed a hospital's

uncompensated costs of providing inpatient hospital and outpatient hospital services

to Medicaid-eligible individuals and uninsured individuals;

(8) "Initial disproportionate share hospital payment" or "Initial DSH payment" means

the state fiscal year DSH payment made to a hospital by the department using data,

subject to limited review, from the hospital's Medicaid DSH survey or proxy

information and which is subject to reconciliation when the hospital's Medicaid

DSH survey is examined;

(9) "Long-term acute hospital" means an in-state hospital that is certified as a long-term

care hospital under 42 U.S.C. sec. 1395ww(d)(1)(B)(iv);

(10) "Low-income utilization rate" or "LIUR" means, for a hospital, the sum of:

(a) A fraction expressed as a percentage, rounded to the nearest hundredth:

1. The numerator of which is the sum for a period of the total Medicaid

revenues paid to the hospital for patient services, regardless of whether

the services were furnished on a fee-for-service basis or through a

managed care entity, and the amount of cash subsidies for patient

services received directly from state and local governments; and

2. The denominator of which is the total amount of revenues of the hospital

for patient services, including the amount of cash subsidies, in the

period; and

(b) A fraction expressed as a percentage rounded to the nearest hundredth:

1. The numerator of which is the total amount of the hospital's charges for

inpatient hospital services which are attributable to charity care in a

period, less the portion of any cash subsidies described in subparagraph

1. of paragraph (a) of this subsection in the period reasonably

attributable to inpatient hospital services, and which shall not include

contractual allowances and discounts other than for indigent patients not

eligible for medical assistance; and

2. The denominator of which is the total amount of the hospital's charges

for inpatient hospital services in the hospital in the period;

(11) "Low-income utilization rate hospital" or "LIUR hospital" means an acute care

hospital whose low-income utilization rate exceeds one hundred twenty percent

(120%) of the state average low-income utilization rate rounded to the nearest

hundredth for all acute care hospitals, critical access hospitals, private psychiatric

hospitals, and university hospitals combined, as reported on the hospitals' Medicaid

DSH surveys;

(12) "Medicaid disproportionate share hospital survey" or "Medicaid DSH survey"

means the report required to be submitted by each hospital receiving Medicaid

disproportionate share payments pursuant to 42 C.F.R. sec. 447.299;

(13) "Medicaid uncompensated care" means the same as in 42 C.F.R. sec.

447.299(c)(11);

(14) "Medicaid inpatient utilization rate" or "MIUR" means, for a hospital, a fraction

expressed as a percentage rounded to the nearest hundredth for which the numerator

shall be the number of in-state and out-of-state inpatient Medicaid days where

Medicaid is the primary payor, covered under fee-for-service and managed care, and

for which the denominator shall be the total number of inpatient days for the

hospital as reported on the hospital's Medicaid DSH survey. However, for a

pediatric teaching hospital, as defined in KRS 205.565, the calculation shall exclude

from the numerator and the denominator the hospital's inpatient Medicaid days

utilized in the calculation of an intensity operating allowance (IOA) payment.

Supplemental information will be requested to support the IOA days included in the

Medicaid DSH survey submission;

(15) "Medicaid inpatient utilization rate hospital" or "MIUR hospital" means an acute

care hospital whose MIUR equals or exceeds one (1) standard deviation above the

mean MIUR rounded to the nearest hundredth for all acute care hospitals, critical

access hospitals, private psychiatric hospitals, and university hospitals combined, as

determined from the hospitals' Medicaid DSH surveys;

(16) "Paid claims listing" or "PCL" means a report created for a hospital by the

department, or by a Medicaid managed care organization using the same format as

the department, with claim level payment information prescribed by the department

in sufficient detail to permit reconciliation with the hospital's internal data for each

Medicaid recipient or managed care enrollee having a discharge date or service date,

as applicable, for inpatient or outpatient services within a hospital's fiscal year;

(17) "Private psychiatric hospital" means a psychiatric hospital licensed under KRS

Chapter 216B that is not a state mental hospital and is not a distinct part unit of a

licensed acute care hospital or operated under the same provider number as a

licensed acute care hospital;

(18) "State mental hospital" means a psychiatric hospital licensed under KRS Chapter

216B that is owned or operated by the Commonwealth;

(19) "Total uncompensated care costs" means the same as in 42 C.F.R. sec.

447.299(c)(16);

(20) "Uninsured uncompensated care costs" means the same as in 42 C.F.R. sec.

447.299(c)(15); and

(21) "University hospital" means a state university teaching hospital, owned or operated

by either the University of Kentucky School of Medicine or the University of

Louisville School of Medicine.