5101:3-2-50 Supplemental inpatient hospital upper limit payments for public hospitals.

(A) "Public hospital" means an Ohio hospital owned and operated by a governmental entity other than the state.

(B) For each public hospital, calculate the estimated amount that medicare would have paid for an inpatient hospital discharge if medicare were paying the care for medicaid consumers.

(1) Divide the total medicare inpatient hospital payment by the hospital's medicare inpatient hospital charges to calculate the hospital-specific medicare payment-to-charge ratio.

(2) Multiply the hospital-specific medicare payment-to-charge ratio by medicaid charges to calculate the estimated medicare payment for medicaid consumers.

(3) For each public hospital, calculate the available payment gap by taking total estimated medicare payment for medicaid discharges as calculated in paragraph (A)(2) of this rule and subtracting actual medicaid payments.

(4) For each public hospital that has an available inpatient payment gap greater than zero resulting from the calculations in paragraph (B)(3) of this rule, calculate the available per-discharge supplemental inpatient hospital payment amount by dividing the amount in paragraph (B)(3) of this rule by the public hospital's medicaid discharges.

(C) The amount calculated in paragraph (B) of this rule will be in effect from July 1, 2011 to June 30, 2013.

(D) The source data for calculations described in this rule will be based on cost reporting data described in rule 5101:3-2-23 of the Administrative Code, which reflects the hospital fiscal year ending state fiscal year 2010, and the medicare cost report (CMS 2552-96) for the corresponding cost reporting period.

(E) Payments will be made on a semi-annual basis, based upon actual medicaid discharges paid during the prior six-month period, subject to the provisions of paragraph (B) of this rule.

(F) Supplemental payments to cost-based providers, as specified in rule 5101:3-2-07.1 of the Administrative Code, will be excluded from the cost settlement process.

(G) Hospital payments made under this section, when combined with other payments made in accordance with this rule, shall not exceed the limit specified in 42 CFR 447.241.

(H) The total funds that will be paid to each public hospital as described in paragraph (E) of this rule will be included in the calculation of disproportionate share limits as described in rule 5101:3-2-07.5 of the Administrative Code.

Replaces: 5101:3-2-50

Effective: 08/24/2012
R.C. 119.032 review dates: 08/01/2017
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021 , Section 309.30.33 of Am. Sub. H.B. 153 of the 129th G.A.
Prior Effective Dates: 11/15/01, 7/1/04, 4/1/09, 4/8/10