DSH

1
DSH Schedules A, B, C and Updates

• Roger Barnes
• DMA Hospital Reimbursement
• November 9, 2006

2
Disclaimer

• This 2006 PowerPoint presentation was developed
  prior to the independent DSH Final Rule,
  Disproportionate Share Hospital Payments,
  CMS-2198-F effective January 19, 2009. This
  final rule supersedes the information in this
  presentation.

Roger Barnes, August 22, 2012
3
(No Transcript)
4
(No Transcript)
5
SCHEDULE A
6
SCHEDULE A
7
(No Transcript)
8
(No Transcript)
9
SCHEDULE B
10
SCHEDULE B
11
SCHEDULE B
12
Continued
13
(No Transcript)
14
(No Transcript)
15
SCHEDULE C
16
SCHEDULE C
17
Unreimbursed Uninsured Patient Charges

• Unreimbursed Uninsured Patient Charges are
  limited to inpatient and outpatient accounts or
  portions thereof for medically necessary services
  which were unpaid in whole or in part.
• Relevant statute 42 U.S.C. 139r-4(g)(1)(A) SSA
  1923 (g)(1)(A)

18
Unreimbursed Uninsured Patient Charges

• The patient had no medical insurance coverage
• The patient had no medical insurance coverage
  that was in effect at the time the services were
  rendered

19
Unreimbursed Uninsured Patient Charges

• The patient had medical insurance coverage in
  effect at the time the services were rendered,
  but the coverage did not extend to the services
  that were rendered or
• The patient had medical insurance coverage in
  effect at the time the services were rendered,
  but coverage was denied for services that would
  have been covered by Medicaid

20
Unreimbursed Uninsured Patient Charges

• You can include U/U charges without regard to
  whether or not the hospital received state or
  local government support payments for indigent or
  low income patients
• Payments received for indigent or low income
  patients by state and local governments can be
  disregarded in calculating Net U/U charges.
• This is for Schedule A only!

21
EXCLUDEDUnreimbursed Uninsured Patient Charges

• Contractual adjustments required by law or
  contract with respect to services provided to
  patients covered by Medicare, Medicaid, or other
  government or private third party payors or
• Services to patients where coverage has been
  denied by the patients public or private payor
  on the basis of lack of medical necessity unless
  the services would have met Medicaid medical
  necessity and coverage criteria.

22
Update of DSH Plan

• State Plan approved effective October 1, 2006
  without sunset dates.
• Rate adjustment payments (Basic DSH) began in
  November 2006.
• First quarterly DSH payment has a target date of
  late January 2007.

23
Update of DSH Plan

• CMS has yet to define a pubic hospital.
• CMS has not issued further definition of
  Unreimbursed Uninsured.
• Final CMS audit regulations of DSH programs have
  not been issued.