10A N.C. Admin. Code 22Q.0106

Current through Register Vol. 39, No. 9, November 1, 2024

Section 22Q .0106 - CERTIFYING HOSPITAL'S PROPORTIONATE SHARE

The Department shall calculate the certifying hospital's proportionate share of outpatient costs as follows:

(1) Adding the certifying hospitals' outpatient costs and each of the eligible hospitals' as defined in 10A NCAC 22R .0103, eligible outpatient costs under 10A NCAC 22R .0104. The sum represents the total of the outpatient costs.

(2) The sum of all certifying hospitals' outpatient costs under Rule .0105 of this Section shall be divided by the total outpatient costs in Item (1) of this Rule. The quotient represents the certifying hospitals' proportionate share, expressed as a decimal.

(3) The amount of available funds shall be multiplied by the certifying hospitals' proportionate share in Item (2) of this Rule. The product represents the funds available for distribution to individual certifying hospitals.

(4) A certifying hospital shall be eligible for a payment from funds available for distribution in Item (3) of this Rule. In each payment period, a certifying hospital shall receive a proportional payment of the available funds based on the certifying hospital's share of outpatient costs for uninsured patients as a percentage of the aggregate of outpatient costs for uninsured patients for certifying hospitals.

(5) Hospitals receiving payments pursuant to this Subchapter shall be subject to the audit and reporting requirements of the North Carolina Medicaid State Plan, Attachment 4.19-A.

10A N.C. Admin. Code 22Q .0106

Authority G.S. 108A-54; 108A-55(c); 143C-9-9;
Temporary Adoption Eff. December 29, 2021;
Eff. August 1, 2022.

Amended by North Carolina Register Volume 37, Issue 05, September 1, 2022 effective 8/1/2022.