2023 Oklahoma Statutes › Title 63. Public Health and Safety › §63-3241.3. Hospital assessment - Exceptions - Fees - Promulgation of rules.

A. For the purpose of assuring access to quality care for Oklahoma Medicaid consumers, the Oklahoma Health Care Authority, after considering input and recommendations from the Hospital Advisory Committee, shall assess hospitals licensed in Oklahoma, unless exempt under subsection B of this section, a supplemental hospital offset payment program fee.
B. The following hospitals shall be exempt from the supplemental hospital offset payment program fee:
1. A hospital that is owned or operated by the state or a state agency, the federal government, a federally recognized Indian tribe, or the Indian Health Service;
2. A hospital that provides more than fifty percent (50%) of its inpatient days under a contract with a state agency other than the Authority;
3. A hospital for which the majority of its inpatient days are for any one of the following services, as determined by the Authority using the Inpatient Discharge Data File published by the State Department of Health, or in the case of a hospital not included in the Inpatient Discharge Data File, using substantially equivalent data provided by the hospital:
a.
treatment of a neurological injury,
b.
treatment of cancer,
c.
treatment of cardiovascular disease,
d.
obstetrical or childbirth services, and
e.
surgical care, except that this exemption shall not apply to any hospital located in a city of less than five hundred thousand (500,000) population and for which the majority of inpatient days are for back, neck, or spine surgery;
4. A hospital that is certified by the federal Centers for Medicare and Medicaid Services as a long-term acute care hospital or as a children's hospital; and
5. A hospital that is certified by the federal Centers for Medicare and Medicaid Services as a critical access hospital.
C. The supplemental hospital offset payment program fee shall be an assessment imposed on each eligible hospital, except those exempted under subsection B of this section, for each calendar year in an amount calculated as a percentage of each eligible hospital's net hospital patient revenue.
1. Funds generated by the supplemental hospital offset payment program fee shall be disbursed for the following purposes in the following priority order:
a.
One Hundred Thirty Million Dollars ($130,000,000.00) to be transferred annually to the Medical Payments Cash Management Improvement Act Programs Disbursing Fund to fund the state Medicaid program,
b.
the nonfederal share of:
(1)
the upper payment limit gap,
(2)
the managed care gap,
(3)
the managed care provider incentive pool to support health care quality assurance and access improvement initiatives, with the pool amount determined by the representative sharing ratio of provider and hospital participation in Medicaid. Provider eligibility shall be determined by the Authority. For purposes of this division, eligible providers shall not include those employed by or contracted with, or otherwise a member of, the faculty practice plan of either:
(a)
a public, accredited Oklahoma medical school, or
(b)
a hospital or health care entity directly or indirectly owned or operated by the entities created pursuant to Section 3224 or 3290 of this title,
(4)
the annual fee to be paid to the Authority under subparagraph c of paragraph 1 of subsection G of Section 3241.4 of this title, and
(5)
Thirty Million Dollars ($30,000,000.00) annually to be transferred by the Authority to the Medical Payments Cash Management Improvement Act Programs Disbursing Fund under subsection C of Section 3241.4 of this title.
If the nonfederal share generated by the supplemental hospital offset payment program fee is not sufficient to fully fund the disbursements described in divisions 1 through 5 of this subparagraph, the funds directed toward such disbursements shall be reduced proportionally, and
c.
any remaining funds shall be deposited into the Medicaid Health Improvement Revolving Fund created in Section 23 of Enrolled Senate Bill No. 1337 of the 2nd Session of the 58th Oklahoma Legislature.
2. The assessment rate until December 31, 2012, shall be fixed at two and one-half percent (2.5%). For the calendar year ending December 31, 2022, the assessment rate shall be fixed at three percent (3%). For the calendar year ending December 31, 2023, the assessment rate shall be fixed at three and one-half percent (3.5%). For the calendar year ending December 31, 2024 and for all subsequent calendar years, the assessment rate shall be fixed at four percent (4%).
3. Net hospital patient revenue shall be determined using the data from each eligible hospital's Medicare Cost Report contained in the federal Centers for Medicare and Medicaid Services' Healthcare Cost Report Information System file.
a.
Through 2013, the base year for assessment shall be the eligible hospital's fiscal year that ended in 2009, as contained in the Healthcare Cost Report Information System file dated December 31, 2010.
b.
For years after 2013, the base year for assessment shall be determined by rules established by the Oklahoma Health Care Authority Board and beginning January 1, 2022, the base year for assessment shall be determined annually.
4. If an eligible hospital's applicable Medicare Cost Report is not contained in the federal Centers for Medicare and Medicaid Services' Healthcare Cost Report Information System file, the eligible hospital shall submit a copy of its applicable Medicare Cost Report to the Authority in order to allow the Authority to determine the eligible hospital's net hospital patient revenue for the base year.
5. If an eligible hospital commenced operations after the due date for a Medicare Cost Report, the eligible hospital shall submit its initial Medicare Cost Report to the Authority in order to allow the Authority to determine the hospital's net patient revenue for the base year.
6. Partial year reports may be prorated for an annual basis.
7. In the event that an eligible hospital does not file a uniform cost report under 42 U.S.C., Section 1396a(a)(40), the Authority shall establish a uniform cost report for such facility subject to the Supplemental Hospital Offset Payment Program provided for in this section.
8. The Authority shall review which hospitals are eligible to participate in the Supplemental Hospital Offset Payment Program provided for in this subsection and which hospitals are exempted pursuant to subsection B of this section. Such review shall occur at a fixed period of time. This review and decision shall occur within twenty (20) days of the time of federal approval and annually thereafter in November of each year.
9. The Authority shall review and determine the amount of the annual assessment. Such review and determination shall occur within the twenty (20) days of federal approval and annually thereafter in November of each year.
D. An eligible hospital may not charge any patient for any portion of the supplemental hospital offset payment program fee.
E. Closure, merger and new hospitals.
1. If an eligible hospital ceases to be an eligible hospital for any reason, the assessment for the year in which the cessation occurs shall be adjusted by multiplying the annual assessment by a fraction, the numerator of which is the number of days in the year during which the hospital is subject to the assessment and the denominator of which is 365. Immediately upon ceasing to be an eligible hospital, the hospital shall pay the assessment for the year as adjusted, to the extent not previously paid.
2. In the case of an eligible hospital that did not operate as a hospital throughout the base year, its assessment and any potential receipt of a hospital access payment will commence in accordance with rules for implementation and enforcement promulgated by the Oklahoma Health Care Authority Board, after consideration of the input and recommendations of the Hospital Advisory Committee.
F. 1. In the event that federal financial participation pursuant to Title XIX of the Social Security Act is not available to the Oklahoma Medicaid program for purposes of matching expenditures from the Supplemental Hospital Offset Payment Program Fund at the approved federal medical assistance percentage for the applicable year for one or more of the purposes identified in division 1, 2, or 3 of subparagraph b of paragraph 1 of subsection C of this section, the portion of the supplemental hospital offset payment program fee attributable to any such purpose for which matching expenditures are unavailable shall be null and void as of the date of the nonavailability of such federal funding through and during any period of nonavailability.
2. In the event of an invalidation of the Supplemental Hospital Offset Payment Program Act by any court of last resort, the supplemental hospital offset payment program fee shall be null and void as of the effective date of that invalidation.
3. In the event that the supplemental hospital offset payment program fee is determined to be null and void for any of the reasons enumerated in this subsection, any supplemental hospital offset payment program fee assessed and collected for any period after such invalidation shall be returned in full within twenty (20) days by the Authority to the eligible hospital from which it was collected.
G. The Oklahoma Health Care Authority Board, after considering the input and recommendations of the Hospital Advisory Committee, shall promulgate rules for the implementation and enforcement of the supplemental hospital offset payment program fee. Unless otherwise provided, the rules adopted under this subsection shall not grant any exceptions to or exemptions from the hospital assessment imposed under this section.
H. The Authority shall provide for administrative penalties in the event a hospital fails to:
1. Submit the supplemental hospital offset payment program fee in a timely manner; or
2. Submit reports as required by this section in a timely manner.
I. The Oklahoma Health Care Authority Board shall have the power to promulgate emergency rules to implement the provisions of the Supplemental Hospital Offset Payment Program Act.
Added by Laws 2011, c. 228, § 3. Amended by Laws 2013, c. 132, § 2, eff. Nov. 1, 2013; Laws 2016, c. 345, § 2, eff. Nov. 1, 2016; Laws 2019, c. 56, § 2, eff. Nov. 1, 2019; Laws 2021, c. 518, § 2; Laws 2022, c. 398, § 2, eff. July 1, 2022.