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Alaska Administrative Code (Last Updated: January 12, 2017) |
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Title 7. Health and Social Services. |
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Part 7.1. Administration. |
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Chapter 7.150. Prospective Payment System; Other Payment. |
Section 7.150.100. Methodology and criteria for proportionate share payments to publicly owned or operated hospitals.
Latest version.
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(a) To implement the provisions of 42 U.S.C. 1396b regarding federal financial participation under Medicaid, and subject to legislative appropriations for that purpose, the department will make a public hospital proportionate share payment to, and receive a funding transfer of public money from, a hospital that qualifies under (1) of this subsection in order to ensure continued access to inpatient hospital services at certain hospitals that provide basic support for community or regional health care, and in order to secure for the state in accordance with AS 47.07.040 the optimum federal participation for inpatient hospital services in the state's medical assistance program. The following procedures and requirements apply to a proportionate share payment under this subsection: (1) to qualify to receive a public hospital proportionate share payment under this subsection, a hospital must (A) be (i) enrolled as a Medicaid provider of inpatient hospital services; (ii) located within the state; and (iii) a public facility; (B) submit an application to the department (i) on a form designated by the department, in which the hospital attests that it meets the requirements of (A) of this paragraph, along with the specified documentation necessary to allow the department to verify that the hospital meets the requirements; and (ii) no later than the date specified in a written announcement distributed by the department; the department will not specify an application submission date that is earlier than 30 days after the date of the department's written announcement; and (C) enter into a written agreement with the department that controls the conditions for receipt of the public hospital proportionate share payment; (2) the department will provide written notification to an applicant hospital of a decision that the hospital has or has not met the requirements of (1) of this subsection; unless a request for reconsideration is filed under (8) of this subsection, the department's decision under this paragraph is the department's final administrative action regarding whether an applicant hospital meets the requirements of (1) of this subsection; (3) the total amount available for distribution as public hospital proportionate share payments under this subsection will be established by the department each year, based on the department's projection of hospital expenditures and within the payment limits of 42 C.F.R. 447.271 - 447.272; subject to legislative appropriation, payment of the amount the department determines to be available for public hospital proportionate share payments will be apportioned among qualifying hospitals based on the relative weight of each qualifying hospital's occupancy level; (4) the department will determine the occupancy level of each qualifying hospital by using the hospital's most recent Medicare cost report on file with the department on April 1 of a year for that hospital's fiscal year that ended 24 months before the beginning of the hospital's fiscal year in which the payment under this subsection is to be made; the hospital may not update or amend the Medicare cost report for the purpose of the proportionate share payment under this subsection; the department will determine the hospital's occupancy level to be the percentage that results from dividing the total number of inpatient days by the total number of available bed days, as both are shown on the Medicare cost report described in this paragraph; (5) the department will assign an occupancy weight for each qualifying hospital in relation to its occupancy level, as follows: Occupancy Occupancy Level Weight 40 percent or more 1.00 unit 30 - 39 percent 1.05 units 20 - 29 percent 1.10 units 10 - 19 percent 1.15 units less than 10 percent 1.20 units (6) the department will determine the dollar value of an occupancy weight unit for the year of payment under this subsection by dividing the total amount of money available for public hospital proportionate share payments by the sum of the occupancy weight units of the qualifying hospitals; (7) the department will determine the amount of a public hospital proportionate share payment under this subsection to a qualifying hospital by multiplying the occupancy weight assigned to the hospital by the value of an occupancy weight unit as calculated under (6) of this subsection; the sum of the payments made to all qualifying hospitals is equal to the total amount of money available for public hospital proportionate share payments in that year; the department will notify each qualifying hospital in writing of the amount of that hospital's payment as determined under this paragraph; unless a request for reconsideration is filed under (9) of this subsection, the department's determination under this paragraph is the department's final administrative action regarding the amount of a qualifying hospital's proportionate share payment under this subsection; (8) a hospital aggrieved by the department's decision under (2) of this subsection may request reconsideration of the decision by filing a request for reconsideration with the department, and sending a copy of the request to each qualifying hospital, no more than 10 days after the date of the department's written notice under (2) of this subsection; the request for reconsideration must state the facts in the record that support a reversal of the initial decision; a qualifying hospital to which a request for reconsideration was sent may file with the department, no more than 10 days after the date the request was sent, a response to the request for reconsideration; the response must be based on facts in the record; the department's decision on reconsideration is the department's final administrative action on a reconsideration request under this paragraph; if the department does not issue a decision on reconsideration 30 days or less after the deadline for filing a response to the request for reconsideration, and does not waive the 30-day deadline, the request is considered denied by the department; the denial is the department's final administrative action on a reconsideration request under this paragraph; (9) a qualifying hospital aggrieved by the department's determination under (7) of this subsection may request reconsideration of the determination by filing a request for reconsideration with the department, and sending a copy of the request to each of the other qualifying hospitals, no more than 10 days after the date of the department's written notice under (7) of this subsection; a request for reconsideration under this paragraph must state the facts in the record supporting a change in the payment amount; a qualifying hospital to which a request for reconsideration was sent may file with the department, no more than 10 days after the date the request was sent, a response to the request for reconsideration; the response must be based on facts in the record; the department's decision on reconsideration is the department's final administrative action on a reconsideration request under this paragraph; if the department does not issue a decision on reconsideration 30 days or less after the deadline for filing a response to the request for reconsideration, and does not waive the 30-day deadline, the request is considered denied by the department; the denial is the department's final administrative action on a reconsideration request under this paragraph; (10) if a decision on reconsideration under this subsection results in a reapportioning of the amount determined under (3) of this subsection to be available for public hospital proportionate share payments, the department will calculate the necessary adjustment to the amount of the payment made under this subsection in that year to the qualifying hospitals; a qualifying hospital shall provide to the department any additional documentation requested by the department in order to make the necessary calculations; the department will notify a hospital in writing of any amount that must be repaid to the department by that hospital as a result of the adjustment; the hospital shall make the repayment to the department promptly after receipt of the department's notice; if the repayment is not made 30 days or less after the date of the department's notice, other payments due to that hospital under AS 47.07 may, consistent with state and federal law, be reduced by the amount not repaid. (b) In this section, unless the context requires otherwise, (1) "qualifying hospital" means a hospital that qualifies under (a)(1) of this section for a public hospital proportionate share payment; (2) "total number of available bed days" means the number shown on line 12, column 2, of worksheet S-3 of the qualifying hospital's Medicare cost report; (3) "total number of inpatient days" means the number shown on line 12, column 6, of worksheet S-3 of the qualifying hospital's Medicare cost report.
Authorities
47.05.010;47.07.040;47.07.070