Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-015 - State Plan Amendment #2009-006

Current through Register Vol. 49, No. 6, June, 2024
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-INPATIENT HOSPITAL SERVICES
ATTACHMENT 4.19-A
1. Inpatient Hospital Services
Non-State
Public Hospital Inpatient Adjustment
4. The
			 difference shall be multiplied by the number of Medicaid discharges at the
			 hospital for the most recent audited fiscal year. The result shall be the
			 amount of the annual Non-State Public Hospital Adjustment.
5. Payment shall be made on a quarterly basis
			 within 15 days after the end of the quarter for the previous quarter. Payment
			 for SFY 2001 shall be prorated proportional to the number of days between April
			 19, 2001 and June 30, 2001 to the total number of days in SFY 2001.
Effective July 1, 2005, all Arkansas non-state government-owned
				or operated acute care and critical access hospitals (that is, all acute care
				and critical access government hospitals within the state of Arkansas that are
				neither owned nor operated by the state of Arkansas) shall qualify for a public
				hospital inpatient rate adjustment. Effective
April 1
,
2009
, Arkansas may provide a public inpatient rate adjustment to
				non-state government owned or operated acute care regional medical center
				hospitals located outside of Arkansas (that is, acute care hospitals outside of
				Arkansas that are neither owned nor operated by any state) that - a) provide
				level 1 trauma and burn care services; b) provide level 3 neonatal care
				services; c) are obligated to serve all patients, regardless of State of origin
and ability to pay
; d) are located within a Standard Metropolitan
				Statistical Area (SMSA) that includes at least 3 States, including Arkansas; e)
				serve as a tertiary care provider for patients residing within a 125 mile
				radius; and f) meet the criteria for disproportionate share hospital under
				Section 1923 of the Social Security Act in at least one State other than the
				one in which the hospital is located. The adjustment shall result in total
				payments to each hospital that are equal to but not in excess of the individual
				facility's Medicare-related upper payment limit, as prescribed in
				42 C.F.R.
				§
										447.272. The adjustment shall be
				calculated as follows:
1.
			 Using data from the hospital's most recently audited cost report, Arkansas
			 shall determine each eligible non-state public hospital's base Medicare per
			 discharge rate and base Medicaid per discharge rate. Base Medicare and Medicaid
			 per discharge rates will include respective Case Mix Index (CMI) adjustments in
			 order to neutralize the impact of the differential between Medicare and
			 Medicaid case mixes.
For hospitals who, for the most recently audited cost report
				year filed a partial year cost report, such partial year cost report data shall
				be annualized to determine their rate adjustment; provided that such hospital
				was licensed and providing services throughout the entire cost report year.
				Hospitals with partial year cost reports who were not licensed and providing
				services throughout the entire cost report year shall receive pro-rated
				adjustments based on the partial year data.
2. The base Medicare per discharge rate shall
			 be multiplied by the applicable upper payment limit (percentage) specified in
			 42 C.F.R.
			 §
									447.272 for non-state government owned
			 or operated hospitals. For example, to the extent that such federal regulation
			 permits Medicaid payments up to 150 percent of the amount that would be paid
			 under Medicare reimbursement principles, the base Medicare per discharge rate
			 shall be multiplied by 150 percent. The result shall be the adjusted Medicare
			 per discharge rate.