1193990 These rules will have the effect of reducing the base payment rates for inpatient hospital services.
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DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF EMERGENCY AND PROPOSED RULEMAKING
The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2001 edition)) and section 6 (6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code §7-771.05(6) (2001; Supp.2008) ) hereby gives notice of the adoption, on an emergency basis, of an amendment to subsections 4801.5 and 4801.7 of chapter 48, title 29 of the District of Columbia Municipal Regulations (DCMR) entitled “Medicaid Reimbursement for Inpatient Hospital Services”.
In February 2011, the Centers for Medicare and Medicaid Services (CMS) approved the District’s All Payors Diagnosis Related Group (APDRG) State Plan amendment which is designed to bring inpatient payment methods to a more current level. This updating process will in turn reflect a more current cost of inpatient care. The effect of these emergency rules will be the creation of new rate payments for APDRG hospitals. The Medicaid Program projects a decrease in total annual expenditures of approximately twenty-three million dollars ($23,000,000) as a result of the proposed change.
Emergency action is necessary for the immediate preservation of the health, safety, and welfare of Medicaid beneficiaries who are in need of hospital services particularly in areas of the city with lower hospital access. By taking emergency action, this proposed rule will ensure appropriate and needed payments to APDRG hospitals and allow Medicaid beneficiaries access to needed medical services.
The corresponding amendment to the District of Columbia State Plan for Medical Assistance (State Plan) must be approved by the Council of the District of Columbia (Council) and the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). These rules shall become effective for inpatient hospital discharges occurring on or after: (1) June 4, 2011, if the corresponding State Plan amendment has been approved by the Council, and by CMS with an effective date of June 4, 2011 or (2) the effective date established by CMS in its approval of the corresponding State Plan amendment. If approved, DHCF will publish a notice which sets forth the effective date of the rules.
The emergency rulemaking was adopted on May 20, 2011, and shall become effective for inpatient hospital discharges occurring on or after June 4, 2011. The emergency rules will remain in effect for one hundred twenty days (120) after the date of adoption (September 16, 2011), unless superseded by publication of a Notice of Final Rulemaking in the D.C. Register. The Director also gives notice of the intent to take final rulemaking action to adopt these rules not less than thirty (30) days after the date of publication of this notice in the D.C. Register.
Chapter 48, MEDICAID PROGRAM: REIMBURSEMENT, of Title 29, PUBLIC WELFARE, of the District of Columbia Municipal Regulations (DCMR) is amended as follows:
Section 4801, CALCULATION OF BASE PAYMENT RATES, is amended as follows:
Subsection 4801.5 is amended to read as follows:
4801.5 The costs set forth in subsection 4801.3 shall be updated to 2007 by applying the 2006 cost-to-charge ratio to claims data for 2007. The cost-to-charge ratios shall be updated on the effective date of these rules and on October 1st every year thereafter.
Subsection 4801.7 is amended to read as follows:
4801.7 Each hospital’s base year payment rate shall not exceed a rate that approximates an overall payment to cost ratio between ninety-five percent (95%) and one hundred percent (100%) for the base year, unless the hospital is in a public-private partnership with the District. The payment to a hospital in a public-private partnership’s base year payment shall be set at a rate that approximates an overall payment to cost ratio of one hundred percent (100%) for the base year. The payment to cost ratio shall be determined by modeling payments to each facility using claims data from the base year data set which shall be subject to a nine and eighty-two hundredth percent (9.82%) reduction beginning on the effective date of these rules.
Comments on the proposed rule shall be submitted in writing, to Dr. Linda Elam, Medicaid Director, Department of Health Care Finance, 899 North Capitol Street, N.E., 6th Floor, Washington, D.C. 20002, within thirty (30) days from the date of publication of this notice in the D.C. Register. Copies of the proposed rule may be obtained from the same address.
