Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter III - Allowances for Services › Section 144-101-III-45 - HOSPITAL SERVICES › Subsection 144-101-III-45.14 - DISPROPORTIONATE SHARE (DSH) PAYMENTS

Current through 2024-29, July 17, 2024
45.14-1
General Eligibility Requirements for DSH Payments
To be eligible for DSH payments a hospital must have at
						least two (2) obstetricians with staff privileges at the hospital who have
						agreed to provide obstetric services to individuals entitled to such services
						under the State Plan. In the case of a hospital located in a rural area that is
						an area outside of a Metropolitan Statistical Area as defined by the Executive
						Office of Management and Budget, the term obstetrician includes any physician
						with staff privileges at the hospital to perform non-emergency obstetric
						procedures. However, the obstetric criteria above do not apply to hospitals in
						which the inpatients are predominantly individuals under eighteen (18) years of
						age or to hospitals that did not offer nonemergency obstetric services as of
						December 21, 1987.
The hospital must also have a MaineCare utilization rate
						of at least one percent (1%). Acute care hospitals must also meet additional
						requirements as described below.
45.14-2
Additional Eligibility
					 Requirements for Acute Care Hospitals
The hospital must also either a) have a MaineCare
						inpatient utilization rate at least one (1) standard deviation above the mean
						MaineCare inpatient utilization rate for hospitals receiving MaineCare payments
						in the state), or b) have a low-income inpatient utilization rate exceeding
						twenty-five percent (25%).
For purposes of determining whether a hospital is a
						disproportionate share hospital in a Payment Year the Department will use data
						from the hospital's Medicare Interim Cost Report for the same period to apply
						the standard deviation test. Interim Cost Settlement Reports for the specified
						payment year must be issued by the Department for all acute care hospitals in
						order for DSH to be calculated by the Department.
45.14-3
Disproportionate Share
					 Payments
A.
DSH Adjustment for
					 Institutions for Mental Disease (IMD)
Subject to the CMS IMD Cap described below and to the
						extent allowed by the Centers for Medicare and Medicaid Services (CMS), the DSH
						adjustment will be one hundred percent (100%) of the actual uncompensated cost,
						as calculated using Medicare Cost Report and GAAP principles, of:
1. services furnished to MaineCare members
					 plus,
2. charity care as reported
					 on the hospital's audited financial statement for the relevant payment year,
					 MINUS
3. payments made by the State
					 for services furnished to MaineCare member.
CMS places a limit on the amount of DSH payment that may
						be made to IMDs (IMD cap). If the Department determines that aggregate payments
						to IMDs, as calculated above, would exceed the CMS IMD cap, payments will be
						made to State-owned facilities first. Remaining IMD DSH payments will be
						allocated among the DSH eligible hospitals based on their relative share of
						applicable DSH payments absent the federal or state cap.
CMS places a limit on the amount of DSH payment that may
						be made to a single hospital. If approved by CMS, if the Department or CMS
						determine that payments to a hospital would exceed that cap, the overage shall
						be redistributed as follows:
If any state-owned hospital has not reached its DSH
						  cap it will receive DSH payments to the extent funds are available up to the
						  limit of its hospital specific cap.
														Remaining IMD DSH funds will be allocated among the
						  DSH eligible hospitals based on their relative share of applicable DSH payments
						  absent the federal or state cap.
The "relative share" is calculated as follows: calculate
						the fraction, the numerator of which is one hundred percent (100%) of actual
						uncompensated cost of a nonstate owned IMD, the denominator of which is the
						total of one hundred percent (100%) of actual uncompensated cost for all
						non-state owned IMDs. That fraction is then multiplied by the remaining
						available for IMD DSH payments, as described above, to give the relative share
						for each non-state-owned IMD.