Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 15 - Hospital Program › Section 13 CSR 70-15.220 - Disproportionate Share Hospital (DSH) Payments

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule implements a new state methodology
				  for paying Disproportionate Share Hospital (DSH) payments in order to comply
				  with the new federally required DSH audit standards. The regulation provides
				  for an interim adjustment to DSH payments and provides for final adjustment to
				  DSH payments based upon the federally mandated DSH audits.
(1) General Reimbursement Principles.
(A) In order to receive federal financial
				participation (FFP), disproportionate share hospital (DSH) payments are made in
				compliance with federal statutes and regulations. Section 1923 of the Social
				Security Act (42 U.S. Code) describes the hospitals that must be paid DSH
				payments and those that the state may elect to pay DSH payments.
(B) Federally-Deemed DSH Hospitals. The state
				must pay disproportionate share payments to hospitals that meet the specific
				obstetric requirements set forth below in paragraph (1)(B)1. and have either a
				Medicaid Inpatient Utilization Rate (MIUR) at least one (1) standard deviation
				above the state mean or a Low Income Utilization Rate (LIUR) greater than
				twenty-five percent (25%). The state shall not make DSH payments in excess of
				each hospital's estimated hospital specific DSH limit.
1. Obstetrics requirements and exemptions.
A. Hospitals must have two (2) obstetricians,
				with staff privileges, who agree to provide non-emergency obstetric services to
				Medicaid eligibles. Rural hospitals, as defined by the federal Executive Office
				of Management and Budget, may qualify any physician with staff privileges as an
				obstetrician.
B. Hospitals are
				exempt from the obstetric requirements if the facility did not offer
				non-emergency obstetric services as of December 22, 1987.
C. Hospitals are exempt if inpatients are
				predominantly under eighteen (18) years of age.
(C) State-Elected DSH Payments. The state may
				elect to make disproportionate share payments to hospitals that meet the
				obstetric requirements set forth in paragraph (1)(B)1. and have a MIUR of at
				least one percent (1%).
(D) Section
				1923(g) of the Social Security Act (Act) limits the amount of DSH payments
				states can pay to each hospital and earn FFP. To be in compliance with the Act,
				DSH payments shall not exceed one hundred percent (100%) of the uncompensated
				care costs of providing hospital services to Medicaid and uninsured
				individuals. Hospital-specific DSH limit calculations must comply with the
				federal DSH rules (42 CFR
				447, Subpart E and
				42 CFR
				455, Subpart D). If the disproportionate
				share payments exceed the hospital-specific DSH limit, the difference shall be
				deducted from disproportionate share payments or recouped from future
				payments.
(E) All DSH payments in
				the aggregate shall not exceed the federal DSH allotment within a state fiscal
				period. The DSH allotment is the maximum amount of DSH payments a state can
				distribute each year and receive FFP.
(F) The state must submit an annual
				independent audit of the state's DSH program to the Centers for Medicare &
				Medicaid Services (CMS). FFP is not available for DSH payments that are found
				to exceed the hospital-specific eligible uncompensated care cost limit. All
				hospitals that receive DSH payments are subject to the independent federal DSH
				audit.
(G) Hospitals qualify for
				DSH for a period of one (1) state fiscal year and must requalify at the
				beginning of each state fiscal year to continue to receive disproportionate
				share payments.