Thank you for the opportunity to comment on the Medicaid Access to Care Initiative Policy (0227–Hospital

Joëlle Dave

Informations

• Publié par: Unjio
• Nombre de lectures: 22
• Langue: English

Extrait

June 19, 2009

Ms. Meghan Sifuentes

Bureau of Medicaid Policy & Actuarial Services

Medical Services Administration

P.O. Box 30479

Lansing, MI 48909-7979

Email: [e-mail]

RE: Project Number 0925-DSH

Dear Ms. Sifuentes,

On behalf of its 144 members, the Michigan Health & Hospital Association (MHA)

appreciates the opportunity to comment on the above referenced proposed policy, which

would implement a revision to Medicaid Disproportionate Share Hospital (DSH) ceiling

calculation methodology.

We also express thanks to the MSA for efforts in hosting the

hospital workgroup meetings with the MHA and hospital representatives. By working

with this group, the MSA is able to obtain hospital input during the development stage of

policy issues, which results in a better outcome for all parties.

This proposed policy addresses a very narrow, but material and important, policy

item as required by the federal DSH auditing and reporting rule, published in the Dec. 19,

2008,

Federal Register

. However, there are other portions of the final DSH rule that are

not followed in the current hospital-specific DSH ceiling calculations. Below are several

key issues not addressed by this policy.

42 CFR §455.304(d)(3) indicates that “only uncompensated care costs of furnishing

inpatient and outpatient hospital services to Medicaid eligible individuals and individuals

with no third party coverage for the inpatient and outpatient hospital services they

received … are eligible for inclusion in the calculation of the hospital-specific

disproportionate share limit payment limit.” The MSA has historically included

unreimbursed inpatient Indigent Care Agreement Plan patients and Third Party Bad

Debts as uncompensated care costs used to determine hospital-specific DSH ceilings.

To

comply with the requirements of the rule, the MHA recommends the MSA exclude

uncompensated care costs for patients with third party coverage from the

calculation of DSH ceilings or risk losing federal matching funds due to non-

compliance.

MHA Comments – 0925-DSH

June 19, 2009

Page 2

In response to comments regarding the inclusion of unreimbursed cost for

Medicare/Medicaid dual eligible patients’ treatment when computing hospital-specific

DSH ceilings, the CMS indicated that it believes “the costs attributable to dual eligibles

should be included in the calculation of the uncompensated costs of serving Medicaid

eligible individuals. But in calculating those uncompensated care costs, it is necessary to

take into account both the Medicare and Medicaid payments made, since those payments

are contemplated under Title XIX.” (page 77912, Federal Register / Vol. 73, No. 245 /

Friday, Dec. 19, 2008). The MSA does not collect such data and therefore does not

include it in its current DSH ceiling calculation.

To comply with the requirements of

the rule, the MHA recommends the MSA include unreimbursed costs for Medicare

dual-eligible patients in the calculation of DSH ceilings.

The final rule indicates Medicaid

eligibility,

not Medicaid payment status is the

trigger for uncompensated care costs to be included in the hospital-specific DSH ceiling

calculations. This would include patients for whom other insurance paid for the entire

stay and patients for whom the hospital did not bill either Medicaid or the assigned HMO

due to an administrative error. The MSA does not collect such data and therefore does not

include it in its current DSH ceiling calculation.

To comply with the requirements of

the rule, the MHA recommends the MSA include unreimbursed costs for “Medicaid

eligible” patients in the calculation of DSH ceilings.

In response to comments regarding the treatment of Medicaid costs and payments for

patients from another state, the CMS indicated that “any Medicaid payments received by

a hospital from any Medicaid agency (in state or out of state) should be counted as

revenue offsets against total incurred Medicaid costs. Any DSH payments received by a

hospital from any Medicaid agency (in state or out of state) must be counted as an offset

against uncompensated care for purposes of the DSH audit and ensuring that the hospital-

specific DSH limit is not exceeded. (page 77946,

Federal Register

/ Vol. 73, No. 245 /

Friday, Dec. 19, 2008). The MSA does not collect such data and therefore does not

include it in its current DSH ceiling calculation.

To comply with the requirements of

the rule, the MHA recommends the MSA include unreimbursed costs for Medicaid

patients from other states in the calculation of DSH ceilings.

The final rule also specifies that cost ratios be derived by cost center while the MSA

currently uses an aggregate Medicaid FFS ratio. However, if Medicaid HMO and

uninsured charges have a different distribution than FFS, the current methodology may

not be sufficient.

The MHA recommends the MSA obtain data to calculate Medicaid

HMO and uninsured specific cost ratios to calculate DSH ceilings.

These issues may have a significant impact at the individual hospital level.

The

MHA recommends the MSA take actions to assure that the FY 2009 DSH ceiling

calculations are conducted accurately in accordance with all of the delineated

aspects of the DSH ceiling calculation requirements.

A comprehensive policy

addressing all of the new requirements should be promulgated for FY 2009. The MHA is

concerned about the failure to fully comply with the CMS’ regulations since the DSH

program will be subject to an annual audit.

MHA Comments – 0925-DSH

June 19, 2009

Page 3

Please contact me at 517-703-8603 should you require clarification or further

information.

Sincerely,

Marilyn Litka-Klein

Vice President, Health Finance