WSR 16-13-041

[Filed June 7, 2016, 3:22 p.m.]

Title or Subject: Medicaid State Plan Amendment (SPA) 16-0025.

Effective Date: July 6, 2016.

Description: The health care authority (the agency) intends to submit medicaid SPA 16-0025 in order to update the definition of "uninsured patient" as it relates to the disproportionate share hospital (DSH) program, to align with the Centers for Medicare and Medicaid Services' (CMS) final rule effective December 3, 2014. Prior to December 3, 2014, "uninsured patient" meant an individual who received hospital services and did not have health insurance or other creditable third party coverage. This definition was "individual-specific," meaning individuals who had coverage but had exhausted that coverage or reached their lifetime limits could not be counted as "uninsured" for the purposes of the DSH program.

Effective December 4, 2014, the definition includes not only those individuals who received hospital services and did not have health insurance or other creditable third party coverage, but includes those who have private insurance coverage and have exhausted those benefits or reached their lifetime limits, as well as medicaid clients who have exhausted applicable state coverage limits. The amended definition is "service-specific," meaning these individuals may now be counted as uninsured for the purposes of the DSH program.

The agency anticipates this SPA will have little, if any, effect on annual aggregate expenditures. CMS notes the final rule should not have a significant financial effect on state medicaid programs. The amended definition does not modify the specific, overall DSH allotment amount paid annually to a state. The definition change should affect those hospitals that are now able to count this "service-specific" population, thereby increasing their DSH eligibility costs, resulting in an increase in the hospital-specific DSH limit. That limit is subtracted from the overall, allotted DSH amount and does not affect that overall allotment.

The SPA s [is] in the development process; therefore a copy is not yet available for review. To contact the agency for additional information and a copy of the SPA when it becomes available, please contact Jean Bui, DSH Program, 626 8th Avenue S.E., Olympia, WA 98501, phone (360) 725-1973, TDD/TTY 1-800-848-5429, fax (253) 350-6512, e-mail jean.bui@hca.wa.gov.