Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.15-008 - SPA #2014-009 & Hospital 5-15

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-A
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-INPATIENT HOSPITAL SERVICES
1.
			 Inpatient Hospital Services
Limited Acute Care Hospital Inpatient Quality
				Incentive Payment
Effective for claims with dates of service on or after January
				1, 2007, all acute care hospitals with the exception of Pediatric Hospitals,
				Border City University-Affiliated Pediatric Teaching Hospitals, Arkansas State
				Operated Teaching Hospitals, Rehabilitative Hospitals, Inpatient Psychiatric
				Hospitals, Critical Access Hospitals, and Out-of-State Hospitals may qualify
				for an Inpatient Quality Incentive Payment. The Inpatient Quality Incentive
				Payment shall be a per diem amount reimbursed in addition to the hospital's
				cost-based interim per diem rate and shall be payable for beneficiaries ages 1
				and above only (does not include children hospitalized on their first
				birthday). The Inpatient Quality Incentive Payment shall equal $50 or 5.9% of
				the interim per diem rate, whichever is lower. The Inpatient Quality Incentive
				Payment reimbursement amounts shall not be included when calculating hospital
				year-end cost settlements.
The State Agency will determine which quality measures will be
				designated for the Inpatient Quality Incentive Payment for the upcoming year
				and the required compliance rate for each measure. The State Agency will
				utilize quality measures which are reported by hospitals under the Medicare
				program. In order to qualify for an Inpatient Quality Incentive Payment, a
				hospital must meet or exceed the compliance rate on two-thirds of the
				designated quality measures designated by the State Agency for the most
				recently completed reporting period. A hospital that meets or exceeds the
				compliance rate on two-thirds of the designated quality measures shall receive
				an Inpatient Quality Incentive Payment for that year.
Inpatient Hospital Access Payments
Effective for services provided on or after July 1, 2009 all
				privately operated hospitals within the State of Arkansas except for
				rehabilitative hospitals and specialty hospitals as defined in Arkansas Code
				Ann. §
								20-77-1901(7)(D) and
				(E) shall be eligible to receive inpatient
				hospital access payments. The inpatient hospital access payments are considered
				supplemental payments and do not replace any currently authorized Medicaid
				inpatient hospital payments.
1. For
			 each rate year, the state shall determine for each hospital and in total the
			 number of Medicaid inpatient discharges for private hospitals eligible for this
			 supplemental payment.
2. For each
			 rate year, the state shall identify, on the basis of paid inpatient discharge
			 claims adjudicated through the State's MMIS,
the aggregate
reimbursement
amount
for inpatient hospital services that were
			 delivered by the private hospitals identified in step one.
Such aggregate
			 amount shall include all other Medicaid inpatient reimbursement to private
			 hospitals eligible for this adjustment and all Medicaid inpatient reimbursement
			 to private hospitals not eligible for this adjustment and shall include all
			 Inpatient Quality Incentive Payments, but shall not include the amount of the
			 pediatric inpatient payment adjustment.
3. The state shall estimate the amount that
			 would have been paid for the services identified in step two using Medicare
			 principles consistent with the upper payment limit (UPL) requirements set forth
			 in
			 42 CFR
			 447.272. Respective Case Mix Indexes (CMI)
			 shall be applied to both the base Medicare per discharge rates and base
			 Medicaid per discharge rates for comparison to the Medicare related
upper
			 payment limit. These case mix adjustments are necessary in order to neutralize
			 the impact of the differential between Medicare and Medicaid patients.
4. The maximum allowable aggregate
			 Medicaid inpatient hospital access payment for private hospitals shall not
			 exceed 97% of the difference between the results of step three (Medicare UPL)
			 and results of step two (Medicaid based payment).
5. Using discharge data identified in step
			 one, the state shall determine each eligible hospital's pro rata percentage
			 which shall be a fraction equal to the number of the hospital's Medicaid
			 discharges divided by the total number of Medicaid discharges for all eligible
			 hospitals. This percentage will be calculated annually.
6. Each eligible hospital's inpatient
			 hospital access payment shall be determined by multiplying the maximum
			 allowable aggregate inpatient access payment identified in step 4 by the pro
			 rata percentage identified in step 5. The current year's adjustment will be
			 based on discharge data from the most recently audited fiscal year for which
			 there is complete data. In this manner, the State will make supplemental
			 payment to eligible hospitals for current year Medicaid utilization.
Inpatient hospital access payments shall be paid on a quarterly
				basis
For hospitals that, for the most recently audited cost report
				period filed a partial year cost report, such partial year cost report data
				shall be annualized to determine their inpatient access payment; provided that
				such hospital was licensed and providing services throughout the entire cost
				report period. Hospitals with partial year cost reports that were not licensed
				and providing services throughout the entire cost report period shall receive
				pro-rated adjustments based on the partial year data.
SUBJECT: Provider Manual Update Transmittal
				HOSPITAL-5-15
REMOVE
INSERT
Section
Date
Section
Date
250.300
10-13-03
250.300
10-1-14
Explanation of Updates
Section 250.300 has been
			 updated to announce the removal of the annual "Private Hospital Inpatient
			 Adjustment" UPL $25.2 million methodology payments.
The paper version of this update transmittal includes revised
				pages that may be filed in your provider manual. See Section I for instructions
				on updating the paper version of the manual. For electronic versions, these
				changes have already been incorporated.
If you have questions regarding this transmittal, please
				contact the HP Enterprise Services Provider Assistance Center at 1-800-457
				-4454 (Toll-Free) within Arkansas or locally and Out-of-State at (501)
				376-2211.
I f you need this material in an
				alternative format, such as large print, please contact the Program Development
				and Quality Assurance Unit at (501) 320-6429.
Arkansas Medicaid provider manuals (including update
				transmittals), official notices, notices of rule making and remittance advice
				(RA) messages are available for downloading from the Arkansas Medicaid
				website:
www.medicaid.state.ar.us.
Thank you for your participation in the Arkansas Medicaid
				Program.
____________________________________________________
Dawn Stehle Director