5101:3-2-07.5 Disproportionate share adjustment.

This rule describes the disproportionate share definition and limitations on payment methods described in rule 5101:3-2-09 of the Administrative Code for the program year specified in paragraph (A)(9) of rule 5101:3-2-08 of the Administrative Code.

(A) For the program year specified in paragraph (A)(9) of rule 5101:3-2-08 of the Administrative Code, paragraphs (B) to (D) of this rule set forth the definition of disproportionate share as well as other procedures and data used for the disproportionate share calculations as described in rule 5101:3-2-09 of the Administrative Code.

(B) Source data for calculations.

The source data used for the calculations made in paragraphs (C) and (D) of this rule will be the hospital's cost-reporting period ending in the state fiscal year as specified in paragraph (B) of rule 5101:3-2-08 of the Administrative Code.

(C) Determination of disproportionate share qualification.

(1) For each hospital calculate the medicaid utilization rate by dividing the sum of total medicaid days and managed care plan (MCP) days as defined in paragraph (A) of rule 5101:3-2-09 of the Administrative Code by total facility days as defined in paragraph (A) of rule 5101:3-2-09 of the Administrative Code.

(2) Each hospital with a medicaid utilization rate greater than or equal to one per cent qualifies as a disproportionate share hospital for the purposes of rule 5101:3-2-09 of the Administrative Code.

(3) Each hospital with a medicaid utilization rate less than one per cent qualifies as a nondisproportionate share hospital for the purposes of rule 5101:3-2-09 of the Administrative Code.

(D) Limitations on disproportionate share and indigent care payments made to hospitals.

(1) For purposes of this rule, for each hospital, calculate medicaid fee for service (FFS) shortfall by subtracting from total medicaid costs, as defined in paragraph (A) of rule 5101:3-2-09 of the Administrative Code, total medicaid payments, as described in paragraph (A) of rule 5101:3-2-09 of the Administrative Code. For those hospitals exempt from the prospective payment system as described in rule 5101:3-2-07.1 of the Administrative Code, the medicaid shortfall equals zero.

(2) For each hospital, calculate the total medicaid shortfall by adding the medicaid FFS shortfall as defined in paragraph (D)(1) of this rule to the medicaid MCP shortfall as defined in paragraph (E)(2)(d) of rule 5101:3-2-09 of the Administrative Code.

(3) For each hospital, determine the total cost of uncompensated care for people without insurance as described in paragraphs (D)(3)(a) to (D)(3)(c) of this rule.

(a) For each hospital, "total inpatient uncompensated care costs for people without insurance" means the sum of the inpatient disability assistance medical costs, uncompensated care costs below the poverty level, and uncompensated care costs above the poverty level amounts from the JFS 02930, schedule F, column 5, line 11.

(b) For each hospital, "total outpatient uncompensated care costs for people without insurance" means the sum of the outpatient disability assistance medical costs, uncompensated care costs below the poverty level, and uncompensated care costs above the poverty level amounts from the JFS 02930, schedule F, column 5, line 15.

(c) For each hospital, total uncompensated care costs for patients without insurance is equal to the sum of paragraphs (D)(3)(a) and (D)(3)(b) of this rule.

(4) For each hospital, determine the amount received under section 1011 - federal reimbursement of emergency health services furnished to undocumented aliens from the JFS 02930, schedule E, line 7b.

(5) For each hospital, calculate the hospital disproportionate share limit by adding the total medicaid shortfall as described in paragraph (D)(2) of this rule and total uncompensated care costs for people without insurance as described in paragraph (D)(3)(c) of this rule and subtracting section 1011 payments as described in paragraph (D)(4) of this rule.

(6) The hospital will receive the lesser of the disproportionate share limit as described in paragraph (D)(5) of this rule or the disproportionate share and indigent care payment as calculated in rule 5101:3-2-09 of the Administrative Code.

Effective: 12/25/2010
R.C. 119.032 review dates: 09/23/2010 and 12/01/2015
Promulgated Under: 119.03
Statutory Authority: 5111.02 , 5112.03
Rule Amplifies: 5111.02 , 5111.021 , 5112.01 , 5112.03
Prior Effective Dates: 10/19/87, 7/1/88 (Emer), 9/29/88, 7/2/92 (Emer), 9/20/92, 7/16/93 (Emer), 9/30/93, 7/24/94, 3/10/95 (Emer), 5/18/95, 3/16/96, 8/7/96 (Emer), 10/21/96, 8/25/97 (Emer), 11/1/97, 8/6/98 (Emer), 9/18/98, 9/15/99, 8/2/01, 9/15/06