Disproportionate Share Payments to Burn Centers
[48 Pa.B. 7462]
[Saturday, December 1, 2018]
The Department of Human Services (Department) is announcing its intent to allocate funds for Fiscal Year (FY) 2018-2019 disproportionate share hospital (DSH) payments to qualifying Medical Assistance (MA) enrolled acute care general hospital burn centers.
For a burn center to qualify for this DSH payment, it must meet one of the following criteria. Unless otherwise stated, the source of the information is the most recent data available from the Pennsylvania Trauma Systems Foundation (PTSF) at the time of calculation.
(1) Is recognized by the American Burn Association and participates in the American Burn Association's, ''Burn Center Verification Program.''
(2) Is certified and accredited as a Level I or Level II Trauma Center by PTSF and has a minimum of 70 annual patient admissions of individuals requiring burn care.
Payments to qualified burn centers will be allocated according to the following:
(1) 50% of the total amount available for qualifying burn centers will be allocated equally among qualified burn centers.
(2) 50% of the total amount available for qualified burn centers will be allocated on the basis of each qualified burn center's percentage of MA and uninsured burn cases and patient days compared to the Statewide total number of MA and uninsured burn cases and patient days for all qualified burn centers. Each qualified burn center will use both in-State and out-of-State cases and patient days. The percentage is calculated as follows:
a) Determine each burn center's percentage of MA and uninsured burn cases by dividing the burn center's total MA and uninsured burn cases by the total number of MA and uninsured burn cases for all qualified burn centers.
b) Multiply the result of (a) by the percentage of MA and uninsured burn cases for all qualified burn centers divided by the total of MA and uninsured burn cases and burn patient days for all qualified burn centers.
c) Determine each burn center's percentage of burn patient days by dividing the burn center's total burn patient days by the total number of burn patient days for all qualified burn centers.
d) Multiply the result of (c) by the percentage of burn patient days for all qualified burn centers divided by the total of MA and uninsured burn cases and burn patient days for all qualified burns centers.
e) Add the results of (b) and (d) for each burn center and multiply by the available funding.
(3) Any eligible burn center that has reached its DSH limit as under Title XIX of the Social Security Act (act) (42 U.S.C.A. §§ 1396—1396w-5) shall receive its share of the State fund available under this act.
All payment limitations are still applicable, including those limitations that the Commonwealth may not exceed its aggregate annual DSH allotment and that no hospital may receive DSH payments in excess of its hospital-specific limit. The Department will not redistribute DSH payments made under this additional class of DSH payments to qualifying hospitals as a result of a qualifying hospital exceeding its hospital-specific DSH limit.
The FY 2018-2019 impact, as a result of the funding allocation for these payments, is $7.921 million ($3.782 million in State general funds and $4.139 million in Federal funds) upon approval by the Centers for Medicare & Medicaid Services.
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. The Department will review and consider comments received within 30 days in determining the final payment methodology for these payments.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
TERESA D. MILLER,
Fiscal Note: 14-NOT-1287. (1) General Fund; (2) Implementing Year 2018-19 is $3,782,000; (3) 1st Succeeding Year 2019-20 through 5th Succeeding Year 2023-24 are $0; (4) 2017-18 Program—$3,782,000; 2016-17 Program—$3,782,000; 2015-16 Program—$3,782,000; (7) Hospital-Based Burn Centers; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 18-1865. Filed for public inspection November 30, 2018, 9:00 a.m.]
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