Sec. 10.09.47.03. Disproportionate Share Payment

A. Free-Standing Acute General, Chronic, or Pediatric/Rehabilitation Hospitals.

(1) Except as set forth in §A(2) of this regulation, the disproportionate share payment for disproportionate share hospitals that are free-standing hospitals licensed as acute general, chronic, or jointly as pediatric and rehabilitation equals an amount determined in accordance with 42 CFR §412.106, but only if the hospital qualifies as a disproportionate share hospital under 42 CFR §412.106.

(2) Free-standing hospitals that are approved by the Program for reimbursement according to rates established by the HSCRC receive a bad debt allowance, which is recognized as a disproportionate share payment equal to or greater than the amount set forth in §A(1) of this regulation, and an additional payment may not be made under this chapter.

B. The disproportionate share payment rate relating to Program payments on or after October 1, 1992 for free-standing hospitals licensed exclusively as:

(1) Psychiatric with charity care inpatient costs:

(a) Exceeding 40 percent of total inpatient hospital costs equals the greater of the:

(i) Hospital's annual low income costs divided by its annual inpatient Medicaid costs, minus 1, all multiplied by 2, and then multiplied by its inpatient Medicaid payment, or

(ii) Minimum payment required by federal law;

(b) Less than or equal to 40 percent of total inpatient hospital costs equals the minimum payment required by federal law;

(2) Rehabilitation with charity care inpatient costs:

(a) Exceeding 20 percent of total inpatient hospital costs equals the greater of the:

(i) Hospital's annual low income costs divided by its annual inpatient Medicaid costs, minus 1, multiplied by its inpatient Medicaid payment, or

(ii) Minimum payment required by federal law;

(b) Less than or equal to 20 percent of total inpatient hospital costs equals the minimum required by federal law.

C. If a hospital qualifies under both §§A(2) and B of this regulation, it is governed by §A(2) of this regulation.

D. Payments according to §A or B of this regulation shall be:

(1) Based on data on annual low-income hospital costs, annual inpatient Medicaid costs, and data pertaining to 42 CFR §412.106 from the complete State fiscal year occurring 2 years before the fiscal year during which payments are made;

(2) Made in one or more payments covering the complete fiscal year; and

(3) Made to appropriate hospital providers that comply with all regulations set forth in COMAR 10.09.92-10.09.95.

E. Out-of-State hospitals determined by the host state Medicaid Program to be a disproportionate share hospital shall be paid a disproportionate share adjustment as determined by the host state Medicaid Program, with a hospital's total adjustment not to exceed 1 percent of the total Maryland Medical Assistance payments to that hospital in a fiscal year.

F. Qualification Requirements.

(1) Except as set forth in §F(2) of this regulation, to qualify as a disproportionate share hospital, a hospital shall supply to the Program, 6 months before the start of the applicable fiscal year:

(a) Information necessary to determine if the hospital qualifies as a disproportionate share hospital; and

(b) Data required under §D(1) of this regulation.

(2) For payments in fiscal year 93, the information required in this section shall be presented to the Department within 10 days of the effective date of these regulations.

G. A free-standing hospital licensed exclusively as psychiatric or rehabilitation for at least 2 years, that has not been a Maryland Medicaid provider for at least 2 years, shall receive a disproportionate share payment, for any year, not greater than the hospital's low-income hospital costs in the complete State fiscal year occurring 2 years before the fiscal year during which payments are made.

H. If it is determined that a payment made to any hospital under this regulation exceeds the actual amount of uncompensated care and would result in reverting funds to CMS, the overpayment shall be used for another provider that received less than that provider was eligible to receive. The redistribution shall be available to all providers that are eligible for disproportionate share payments except those whose rates are set by HSCRC.