Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 10 - Office of the Director › Chapter 33 - Hospital and Ambulatory Surgical Center Data Disclosure › Section 19 CSR 10-33.030 - Reporting Financial Data by Hospitals

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes procedures for
				  reporting financial data by hospitals to the Department of
				  Health.
(1) Hospitals shall
				report the financial data listed in Exhibit D of this rule, included herein,
				for the previous fiscal year to the Department of Health by April 15 of each
				year starting in 1993. If any data element has been submitted previously to the
				Division of Medical Services of the Department of Social Services, the hospital
				does not have to report that data to the Department of Health. The Department
				of Health shall notify each hospital what data elements are not available from
				the Division of Medical Services.
(2) Hospitals may provide the financial data
				directly or through an association to the Department of Health from the
				financial section of the annual licensing survey.
(3) The Department of Health shall develop
				and publish reports pertaining to individual hospitals. The reports and the
				data they contain shall be public information and may be released on magnetic
				media. The Department of Health shall make the reports and data available for a
				reasonable charge based upon incurred costs.
(4) The Department of Health may develop
				reports and release data upon request which do not directly or indirectly
				identify individual hospitals. The reports and data shall be public information
				and may be released on magnetic media. The Department of Health shall make the
				reports and data available for a reasonable charge based upon incurred
				costs.
(5) Any provider which
				determines it temporarily will be unable to comply with any of the provisions
				of this rule or with the provisions of a previously-submitted plan of
				correction can provide the Department of Health with written notification of
				the expected deficiencies and a written plan of correction. The notification
				and plan of correction shall include the section number and text of the rule in
				question, specific reasons why the provider cannot comply with the rule, an
				explanation of any extenuating factors which may be relevant, the means the
				provider will employ for correcting the expected deficiency and the date by
				which each corrective measure will be completed.
(6) Any provider which is not in compliance
				with this rule shall be notified in writing by the Department of Health. The
				notification shall specify the deficiency and the action which must be taken to
				be in compliance. The chief executive officer or designee shall have ten (10)
				working days following receipt of the written notification of noncompliance to
				provide the Department of Health with a written plan for correcting the
				deficiency. The plan of correction shall specify the means the provider will
				employ for correcting the cited deficiency and the date that each corrective
				measure will be completed.
(7) Upon
				receipt of a required plan of correction, the Department of Health shall review
				the plan to determine the appropriateness of the corrective action. If the plan
				is acceptable, the Department of Health shall notify the chief executive
				officer or designee in writing and indicate that implementation of the plan
				should proceed. If the plan is not acceptable, the Department of Health shall
				notify the chief executive officer or designee in writing and indicate the
				reasons why the plan was not accepted. A revised, acceptable plan of correction
				shall be provided to the Department of Health within ten (10) working
				days.
(8) Failure of the provider
				to submit an acceptable plan of correction within the required time shall be
				considered continued and substantial noncompliance with this rule unless
				determined otherwise by the director of the Department of Health.
(9) Failure of any provider to follow its
				accepted plan of correction shall be considered continued and substantial
				noncompliance with this rule unless determined otherwise by the director of the
				Department of Health.
(10) Any
				provider in continued and substantial noncompliance with this rule shall be
				notified by registered mail and reported by the Department of Health to its
				Bureau of Hospital Licensing and Certification, Bureau of Narcotics and
				Dangerous Drugs, Bureau of Emergency Medical Services, Bureau of Home Health
				Licensing and Certification, Bureau of Radiological Health, State Public Health
				Laboratory, Bureau of Special Health Care Needs, the Division of Medical
				Services of the Department of Social Services, the Division of Vocational
				Rehabilitation of the Department of Elementary and Secondary Education and to
				other state agencies that administer a program with provider participation. The
				Department of Health shall notify the agencies that the provider is no longer
				eligible for participation in a state program.
(11) Any provider that has been declared to
				be ineligible for participation in a state program shall be eligible for
				reinstatement by correcting the deficiencies and making written application for
				reinstatement to the Department of Health. Any provider meeting the
				requirements for reinstatement shall be notified by registered mail. The
				Department of Health shall notify state agencies that administer a program with
				provider participation that the provider's eligibility for participation in a
				state program has been reinstated.
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Definitions for Exhibit D
Balance Sheet*
1a.
Cash and cash equivalents
means money on hand, and includes
				money in checking accounts, time deposits, temporary cash investments and
				uninvested funds held by investment custodians.
1b.
Net patient accounts
				receivable
means accounts receivable, net of estimated
				uncollectibles.
1c.
Other
				current assets
means other accounts receivable, notes receivable and
				may include the current portion of assets whose use is limited, prepaid
				expenses, inventory and short-term investments.
1d.
Total current assets
means the sum of lines 1a. through 1c.
2a.
Fixed assets at cost
means land, land improvements, buildings and improvements, leasehold
				improvements, equipment (fixed and movable), leased property and equipment, and
				construction in progress, at cost.
2b.
Accumulated depreciation
means depreciation and amortization.
2c.
Fixed assets (net)
means
				fixed assets at cost (line 2a.) less accumulated depreciation (line
				2b.).
3.
Other
				assets
means all other assets, and may include deferred financing
				costs, unamortized bond issue costs, investment in affiliated company, deferred
				third-party reimbursement and other assets.
4.
Total assets
means the
				sum of lines 1d., 2c. and 3.
5.
Current liabilities
means those which will be discharged with
				current assets, and may include notes payable to banks; the current portion of
				long-term debt; accounts payable; advances from and amounts payable to
				third-party payers for estimated and final reimbursement settlements; refunds
				to and deposits from patients and others; deferred revenue; accrued salaries
				and payroll taxes; and other accruals such as pension or profit-sharing
				contributions, compensated absences, and income and other taxes.
6.
Long-term debt
means
				notes payable, mortgages payable, capital leases, bonds payable and
				loans/contracts payable.
7.
Other long-term liabilities
means other long-term obligations,
				and may include estimated malpractice costs, deferred compensation payable,
				deferred third-party reimbursement and accrued pension/deferred pension
				liability.
8.
Fund
				balance
means the excess of assets over liabilities (net equity). An
				excess of liabilities over assets is reflected as a deficit.
9.
Total liabilities and fund
				balance
means the sum of lines 5.-8. Must agree with total assets,
				line 4.
Income Statement**
1a.
Inpatient revenue
means
				full hospital charges for all hospital services to inpatients.
1b.
Outpatient revenue
means
				full hospital charges for all hospital services to outpatients.
1c.
Total gross patient
				revenue
means the sum of lines 1a. and 1b. Full hospital charges for
				all hospital patient services before considering any deductions for charity
				care or contractual allowances.
2b.
Other allowances and deductions
means revenue deductions
				incurred in treating patients other than charity patients, including Medicare,
				Medicaid, other insured and uninsured patients. It includes courtesy discounts
				given to employees and others. It does not include bad debt expense, which is
				to be reported as an operating expense (line 6d.).
2c.
Total allowance and
				deductions
means the sum of lines 2a. and 2b.
3.
Net patient revenue
means
				total gross revenue (line 2.) less total allowances and deductions (line
				2c.).
4.
Other
				revenue
means revenue from services other than health care provided to
				patients and residents, and includes sales and services to nonpatients. This
				revenue arises from the normal day-to-day operations of the health care entity.
				Other revenues may include: revenue such as gifts, grants, or endowment income
				restricted by donors to finance charity care; revenue from educational
				programs; revenue from research and other gifts and grants; revenue from
				miscellaneous sources, such as rental of facility space, sales of medical and
				pharmacy supplies, fees charged for transcripts for attorneys, insurance
				companies and others, proceeds from the sale of cafeteria meals and guest
				trays, proceeds from the sale of scrap, used X-ray film, and proceeds from
				sales at gift shops, snack bars, newsstands, parking lots, vending machines and
				other service facilities operated by the health care entity.
5.
Total revenue
means the
				sum of lines 3. and 4.
6a.
Payroll expenses
means salaries and wages paid to employees of
				the health care entity.
6b.
Employee benefits
means Social Security, group insurance,
				retirement benefits, Workers' Compensation, unemployment insurance and
				others.
6c.
Depreciation
				expense
means depreciation and amortization of property and equipment
				recorded for the reporting period.
6d.
Bad debt expense
means
				revenue amounts deemed uncollectible primarily because of a patient's
				unwillingness to pay as determined after collection efforts based upon sound
				credit and collection policies. It does not include charity care, which is to
				be reported on line 2a.
6e.
All other operating expenses
means expenses for professional
				fees, interest, supplies, purchased services, utilities, income taxes,
				operating losses and any other expenses not included in the above
				categories.
6f.
Total
				operating expenses
means the sum of lines 6a.-6e.
7.
Income from operations
means total revenue (line 5.) less total operating expenses (line
				6f.).
8a.
Investment
				income
means return on investments of general funds, except that
				investment income and realized gains and losses on borrowed funds held by a
				trustee, investment income on malpractice trust funds and investment income
				that is essential to the ongoing major or central operations are included in
				other revenue (line 4.).
8b.
Contributions
means contributions, donations and bequests for
				general operating purposes from foundations, similar groups or individuals, or
				any combination of these.
8c.
Tax support and other subsidies
means tax levies and other
				subsidies from governmental or community agencies received for general support
				of the entity.
8d.
Miscellaneous gains and losses
means all other gains and
				losses from a provider's peripheral or incidental transactions, such as gain or
				loss on sale of health care entity properties; net rentals of facilities used
				in the operation of the entity; and term endowment funds that are available for
				general operating purposes upon termination of restrictions.
8e.
Nonoperating gains and
				losses
means the sum of lines 8a.-8d.
9.
Net income before extraordinary
				and other nonrecurring items
means the sum of net income from
				operations (line 7.) and nonoperating gains and losses (line 8e.).
10.
Extraordinary gains and
				losses
means gains or losses unusual in amount and nonrecurring in
				nature that do not result from normal operating activities. Events or
				transactions that occur frequently in the health care environment, such as
				large, unrestricted gifts, cannot be regarded as extraordinary, regardless of
				their financial effect, and are to be included in ordinary income.
11.
Net income
means the sum
				of lines 9. and 10.
Supplemental Items***
1.
Funded depreciation
means
				cash resources which have been set aside and accumulated for the purpose of
				financing the renewal or replacement of plant assets.
2a.
Medicare gross patient
				revenue
means full hospital charges for all hospital services provided
				to Medicare patients.
2b.
Medicaid gross patient revenue
means full hospital charges for
				all hospital services provided to Medicaid patients.
2c.
Other government patient
				revenue
means full hospital charges for all hospital services provided
				to other government patients, including CHAMPUS, government retirement and
				Crippled Children's Service.
2d.
Nongovernment patient revenue
means full hospital charges for
				all hospital services provided to nongovernment patients, including those with
				private insurance, those belonging to HMOs or PPOs, and those without
				insurance.