Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-041 - State Plan Amendment #2008-015 - Private Hospital Inpatient Rate Adjustment

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.
Private Hospital Inpatient
				Adjustment
Effective April 19, 2001, all Arkansas private acute care and
				critical access hospitals (that is, all acute care and critical access
				hospitals within the state of Arkansas that are neither owned nor operated by
				state or local government), with the exception of private pediatric hospitals,
				shall qualify for a private hospital inpatient rate adjustment. Effective
				August 1, 2002, all Arkansas private inpatient psychiatric and rehabilitative
				hospitals (that is, all inpatient psychiatric and rehabilitative hospitals
				within the state of Arkansas that are neither owned nor operated by state or
				local government) shall qualify for a private hospital inpatient rate
				adjustment. The adjustment shall be equal to each eligible hospital's pro rata
				share of a funding pool, based on the hospital=s Medicaid discharges. The
				adjustment shall be calculated as follows:
1. The amount of the funding pool shall be
			 $24,200,000 for State Fiscal Year (SFY) 2007
,
$25,200,000 for SFY
			 2008
and $25,200,000 for all following SFYs.
2. For each private hospital eligible for the
			 adjustment, Arkansas shall determine the number of Medicaid discharges for the
			 hospital for the most recent audited fiscal year.
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.