Section IIHospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD)250.622Arkansas State Operated Teaching Hospital AdjustmentEffective May 9, 2000, Arkansas State Operated Teaching Hospitals qualify for an inpatient rate adjustment.
A. The adjustment shall result in total payments to the hospitals that are equal to but not in excess of the individual facility's Medicare-related upper payment limit.B. The adjustment is calculated as follows: 1. Using the most current audited data, Arkansas Medicaid determines each State Operated Teaching Hospital's base Medicare per discharge rate and base Medicaid per-discharge rate. a. Arkansas Medicaid will use the date of the Medicaid Notice of Provider Reimbursement (NPR) received by the Division of Medical Services from the Medicare Intermediary to determine the most recent audited cost report period for rate adjustment purposes.b. The most current audited cost report period is used when an earlier period's NPR is finalized after a later period's.c. In order to be used to calculate the rate adjustment amount, the Medicaid NPR received from the Medicare Intermediary must be dated before July 1 of the state fiscal year (SFY) for which the adjustment payments will be made.2. The base per-discharge rates are trended forward to the current fiscal year using an annual Consumer Price Index inflation factor.3. Once the per-discharge rates have been trended forward, the Medicare per-discharge rate is divided by the Medicare case mix index and the Medicaid per-discharge rate is divided by the Medicaid case mix index.a. The Medicare case mix index reflects the hospital's average diagnosis related group (DRG) weight for Medicare patients.b. The Medicaid case mix index reflects the hospital's average DRG weight for Medicaid patients using the Medicare DRGs.4. The base Medicaid per-discharge rate is subtracted from the base Medicare per discharge rate.5. The difference is multiplied by the hospital's Medicaid case mix index.6. The adjusted difference is multiplied by the number of Medicaid discharges at the hospital for the most recent fiscal year.7. The result is the amount of the annual State Operated Teaching Hospital Adjustment.8. Payment is made on an annual basis before the end of the state fiscal year (June 30).9. Effective for state fiscal year 2016 and forward, the state may elect to use the most recent cost report available as of June 30 if the audited cost report is more than 2 years old as of June 30 for the above calculation.250.624Non-State Public Hospital Inpatient AdjustmentAll Arkansas non-state government-owned or operated acute care and critical access hospitals (that is, all acute care and critical access government hospitals within the state of Arkansas that are neither owned nor operated by the state of Arkansas) shall qualify for a public hospital inpatient rate adjustment.
A. The adjustment shall result in total payments to each hospital that are equal to but not in excess of the individual facility's Medicare-related upper payment limit, as prescribed in 42 CFR § 447.272. The adjustment shall be calculated as follows.1. Using data from the hospital's most recent audited cost report, Arkansas Medicaid shall determine each eligible non-state public hospital's base Medicare per discharge rate and its base Medicaid per discharge rate a. Base Medicare and Medicaid per discharge rates will include respective Case Mix Index (CMI) adjustments in order to neutralize the impact of the differential between Medicare and Medicaid case mixes.b. Arkansas Medicaid will use the date of the Medicaid Notice of Provider Reimbursement (NPR) received by the Division of Medical Services from the Medicare Intermediary to determine the most recent audited cost report period for rate adjustment purposes.c. The most current audited cost report period is used when an earlier period's NPR is finalized after a later period's.d. In order to be used to calculate the rate adjustment amount, the Medicaid NPR received from the Medicare Intermediary must be dated before July 1 of the state fiscal year (SFY) for which the adjustment payments will be made.2. If an ownership change occurs, the previous owner's audited fiscal periods will be used when audited cost report information is not available for the current owner.3. For a hospital that, for the most recent audited cost report year filed a partial year cost report, such partial year cost report data shall be annualized to determine the hospital's rate adjustment; provided that such hospital was licensed and providing services throughout the entire cost report year.4. Hospitals with partial year cost reports which were not licensed and providing services throughout the entire cost report year shall receive pro-rated adjustments based on the partial year data.B. The base Medicare per discharge rate shall be multiplied by the applicable upper payment limit (percentage) specified in 42 CFR § 447.272 for non-state government owned or operated hospitals.1. For example, to the extent that such federal regulation permits Medicaid payments up to 150 percent of the amount that would be paid under Medicare reimbursement principles, the base Medicare per discharge rate shall be multiplied by 150 percent.2. The result shall be the adjusted Medicare per discharge rate.3. The base Medicaid per discharge rate shall then be subtracted from the adjusted Medicare per discharge rate.4. The difference shall be multiplied by the number of Medicaid discharges at the hospital for the most recent audited fiscal year. The result shall be the amount of the annual Non-State Public Hospital Adjustment.C. Payment shall be made on a quarterly basis within 15 days after the end of the quarter for the previous quarter.D. Effective for state fiscal year 2016 and forward, the state may elect to use the most recent cost report available as of June 30 if the audited cost report is more than 2 years old as of June 30 for the above calculation.250.625Inpatient Adjustment for Non-State Public Hospitals Outside ArkansasEffective April 1, 2006 through December 31, 2006, Arkansas may provide a public inpatient rate adjustment to non-state government owned or operated acute care regional medical center hospitals located outside of Arkansas (that is, acute care hospitals outside of Arkansas that are neither owned nor operated by any state) that:
a) Provide level 1 trauma and burn care services; b) Provide level 3 neonatal care services; c) Are obligated to serve all patients, regardless of the patient's state of origin; d) Are located within a Standard Metropolitan Statistical Area (SMSA) that includes at least 3 states, including Arkansas; e) Serve as a tertiary care provider for patients residing within a 125 mile radius; and f) Meet the criteria for disproportionate share hospital under Section 1923 of the Social Security Act in at least one state other than the state in which the hospital is located. The adjustment shall result in total payments to each hospital that are equal to but not in excess of the individual facility's Medicare-related upper payment limit, as prescribed in 42 CFR § 447.272. The adjustment shall be calculated as follows.
A. Using data from the hospital's most recent audited cost report, Arkansas Medicaid shall determine each eligible non-state public hospital's base Medicare per discharge rate and its base Medicaid per discharge rate 1. Base Medicare and Medicaid per discharge rates will include respective Case Mix Index (CMI) adjustments in order to neutralize the impact of the differential between Medicare and Medicaid case mixes.2. Arkansas Medicaid will use the date of the Medicaid Notice of Provider Reimbursement (NPR) received by the Division of Medical Services from the Medicare Intermediary to determine the most recent audited cost report period for rate adjustment purposes.3. The most current audited cost report period is used when an earlier period's NPR is finalized after a later period's.4. In order to be used to calculate the rate adjustment amount, the Medicaid NPR received from the Medicare Intermediary must be dated before July 1 of the state fiscal year (SFY) for which the adjustment payments will be made.5. If an ownership change occurs, the previous owner's audited fiscal periods will be used when audited cost report information is not available for the current owner.6. For a hospital that, for the most recent audited cost report year filed a partial year cost report, such partial year cost report data shall be annualized to determine the hospital's rate adjustment; provided that such hospital was licensed and providing services throughout the entire cost report year.7. Hospitals with partial year cost reports which were not licensed and providing services throughout the entire cost report year shall receive pro-rated adjustments based on the partial year data.B. The base Medicare per discharge rate shall be multiplied by the applicable upper payment limit (percentage) specified in 42 CFR § 447.272 for non-state government owned or operated hospitals.1. For example, to the extent that such federal regulation permits Medicaid payments up to 150 percent of the amount that would be paid under Medicare reimbursement principles, the base Medicare per discharge rate shall be multiplied by 150 percent.2. The result shall be the adjusted Medicare per discharge rate.3. The base Medicaid per discharge rate shall then be subtracted from the adjusted Medicare per discharge rate.4. The difference shall be multiplied by the number of Medicaid discharges at the hospital for the most recent audited fiscal year. The result shall be the amount of the annual Non-State Public Hospital Adjustment.C. Payment shall be made on a quarterly basis within 15 days after the end of the quarter for the previous quarter.D. Effective for state fiscal year 2016 and forward, the state may elect to use the most recent cost report available as of June 30 if the audited cost report is more than 2 years old as of June 30 for the above calculation.250.626In-State Private Pediatric Inpatient AdjustmentAll Arkansas private pediatric hospitals qualify for a pediatric hospital inpatient rate adjustment. The amount of the adjustment shall be determined annually by Arkansas Medicaid based on available funding. Each qualifying hospital's adjustment amount shall be equal to their pro rata share of the total adjustment based on the hospital's Medicaid discharges for the most recent audited final year. In no case shall the pediatric hospital adjustment be in an amount that results in aggregate Medicaid inpatient payments to all private hospitals (including the private hospital inpatient rate adjustment) that are in excess of the applicable Medicare-related upper payment limit specified in 42 C.F.R § 447.727.
If an ownership change occurs, the previous owner's audited fiscal periods will be used when audited cost report information is not available for the current owner.
Effective for state fiscal year 2016 and forward, the state may elect to use the most recent cost report available as of June 30 if the audited cost report is more than 2 years old as of June 30 for the above calculation.
250.627Non-State Government Owned or Operated Outpatient UPL Reimbursement AdjustmentArkansas non-state government-owned or operated acute care/general hospitals (that is, all acute care government hospitals within the state of Arkansas that are neither owned nor operated by the State of Arkansas) shall qualify for an annual upper payment limit (UPL) reimbursement adjustment. Psychiatric hospitals, pediatric hospitals, rehabilitative hospitals and critical access hospitals are not eligible for an adjustment. Payment shall be made before the end of the state fiscal year (SFY). The adjustment will be calculated and based on each hospital's previous SFY outpatient Medicare-related upper payment limit (UPL as specified in 42 CFR 447.321 ) for Medicaid reimbursed outpatient services. The adjustments will be calculated as follows:
A. For each qualifying hospital, Arkansas Medicaid will annually identify the total Medicaid outpatient expenditures during the most recent completed SFY.B. For each qualifying hospital, the total Medicaid expenditures are determined in step A, and are divided by 80% to estimate the amount that would have been paid using Medicare reimbursement principles.C. The difference between step A identified Medicaid expenditures and step B estimated Medicare amounts is the UPL annual adjustment amount that will be reimbursed. Eligible hospitals that were not licensed and providing services throughout the most recent completed SFY shall receive a pro-rated adjustment based on the partial year data.
D. Payment for SH+FY 2003 shall be pro-rated proportional to the number of days between April 1, 2003 and June 30, 2003 to the total number of days in SFY 2003.E. If an ownership change occurs, the previous owner's audited fiscal periods will be used when audited cost report information is not available for the current owner.F. Effective for state fiscal year 2016 and forward, the state may elect to use the most recent cost report available as of June 30 if the audited cost report is more than 2 years old as of June 30 for the above calculation.250.628Inpatient Hospital Access PaymentsAll Arkansas private hospitals (that is, all hospitals within the state of Arkansas that are neither owned nor operated by state or local government), with the exception of private rehabilitative and specialty hospitals, qualify for a private hospital inpatient access payment.
The inpatient access payment shall be equal to each eligible hospital's pro rata share of a funding pool, based on the hospital's Medicaid discharges. The amount of the funding pool shall be determined annually by Arkansas Medicaid based on available funding.
The access payments shall be calculated as follows:
A. Arkansas Medicaid shall annually determine the amount of available funding for the private hospital access payment funding pool. The maximum allowable aggregate Medicaid inpatient hospital access payment for private hospitals will not exceed 97% of the difference between the Medicaid UPL and the Medicaid-based payments.B. For each private hospital eligible for the access payment, Arkansas Medicaid shall determine the number of Medicaid discharges for the most recent audited fiscal period. 1. Arkansas Medicaid will use the date of the Medicaid Notice of Provider Reimbursement (NPR) received by the Division of Medical Services from the Medicare Intermediary to determine the most recent audited cost report period.2. The most current audited cost report period is used when an earlier period's NPR is finalized after a later period's.3. In order to be used to calculate the access payments, the Medicaid NPR received from the Medicare Intermediary must be dated before July 1 of the state fiscal year (SFY) for which the payments will be made.4. If an ownership change occurs, the previous owner's audited fiscal periods will be used when audited cost report information is not available for the current owner.5. For hospitals that filed a partial year cost report for the most recently audited cost report year, such partial year cost report data shall be annualized to determine their access payment, provided that such hospital was licensed and providing services throughout the entire cost report year. Hospitals with partial year cost reports that were not licensed and providing services throughout the entire cost report year shall receive pro-rated payments based on the partial year data.C. To the extent that this private hospital access payment results in payments in excess of the upper payment limit, such payments shall be reduced on a pro rata basis according to each hospital's Medicaid discharges. Such reduction shall be no more than the amount necessary to ensure that aggregate Medicaid inpatient reimbursement to private hospitals is equal to but not in excess of the upper payment limit.D. For each eligible private hospital, Arkansas Medicaid shall determine its pro rata percentage, which shall be a fraction equal to the number of the hospital's Medicaid discharges divided by the total number of Medicaid discharges of all eligible hospitals.E. The amount of each eligible hospital's access payment shall be its pro rata percentage multiplied by the amount of available funding for the inpatient hospital access payment pool as determined by Arkansas Medicaid.F. Inpatient hospital access payments shall be made on a quarterly basis.G. Effective for state fiscal year 2016 and forward, the state may elect to use the most recent cost report available as of June 30 if the audited cost report is more than 2 years old as of June 30 for the above calculation.250.629Outpatient Hospital Access PaymentsAll Arkansas private hospitals (that is, all hospitals within the state of Arkansas that are neither owned nor operated by state or local government), with the exception of private rehabilitative and specialty hospitals, qualify for a private hospital outpatient access payment.
The outpatient access payment shall be equal to each eligible hospital's share of a funding pool, pro-rated based on the hospital's paid claims adjudicated for outpatient hospital services. The amount of the funding pool shall be determined annually by Arkansas Medicaid based on available funding.
The access payments shall be calculated as follows:
A. Arkansas Medicaid shall annually determine the amount of available funding for the private hospital access payment funding pool by using the Medicare cost principles consistent with the upper payment limit (UPL) requirements set forth in 42 CFR 447.321. The maximum allowable aggregate Medicaid outpatient hospital access payment for private hospitals shall not exceed the difference between the results of Medicaid-based payments and the Medicaid outpatient hospital services cost.B. For each private hospital eligible for the adjustment, Arkansas Medicaid shall determine the Medicaid paid claims adjudicated for outpatient hospital services for the most recent audited fiscal period.1. Arkansas Medicaid will use the date of the Medicaid Notice of Provider Reimbursement (NPR) received by the Division of Medical Services from the Medicare Intermediary to determine the most recent audited cost report period for access payment purposes.2. The most current audited cost report period is used when an earlier period's NPR is finalized after a later period's.3. In order to be used to calculate the access payment amount, the Medicaid NPR received from the Medicare Intermediary must be dated before July 1st of the state fiscal year (SFY) for which the payments will be made.4. If an ownership change occurs, the previous owner's audited fiscal periods will be used when audited cost report information is not available for the current owner.5. For hospitals that filed a partial year cost report for the most recently audited cost report year, such partial year cost report data shall be annualized to determine their access payments, provided that such hospitals were licensed and providing services throughout the entire cost report year. Hospitals with partial year cost reports that were not licensed and providing services throughout the entire cost report year shall receive pro-rated access payments based on the partial year data.C. For each eligible private hospital, Arkansas Medicaid shall determine its pro rata percentage, which shall be a fraction equal to the hospital's Medicaid paid claims adjudicated for outpatient hospital services divided by the total Medicaid paid claims adjudicated for outpatient hospital services of all eligible hospitals.D. Outpatient hospital access payments shall be paid on a quarterly basis.E. Effective for state fiscal year 2016 and forward, the state may elect to use the most recent cost report available as of June 30 if the audited cost report is more than 2 years old as of June 30 for the above calculation.