(1) The medicaid agency makes small rural indigent assistance disproportionate share hospital (SRIADSH) program payments to qualifying small rural hospitals through the disproportionate share hospital (DSH) program.
(2) To qualify for an SRIADSH payment, a hospital must:
(a) Not be participating in the "full cost" public hospital certified public expenditure (CPE) payment program as described in WAC 182-550-4650
(b) Not be designated as an "institution for mental diseases (IMD)" as defined in WAC 182-550-2600
(d) Have fewer than seventy-five acute beds;
(e) Be an in-state hospital that provided charity services to clients during the base year. A hospital located out-of-state or in a designated bordering city is not eligible to receive SRIADSH payments; and
(f) Be located in a city or town with a nonstudent population of no more than seventeen thousand eight hundred six in calendar year 2008, as determined by the Washington State office of financial management population of cities, towns, and counties used for the allocation of state revenues. This nonstudent population is used for SFY 2010, which begins July 1, 2009. For each subsequent SFY, the nonstudent population ceiling is increased by two percent.
(3) The agency pays hospitals qualifying for SRIADSH payments from a legislatively appropriated pool. The agency determines each hospital's individual SRIADSH payment from the total dollars in the pool using percentages established through the following prospective payment method:
(a) At the time the SRIADSH payment is to be made, the agency calculates each hospital's profitability margin based on the hospital's base year data and audited financial statements.
(b) The agency determines the average profitability margin for all hospitals qualifying for SRIADSH.
(c) Any qualifying hospital with a profitability margin of less than one hundred ten percent of the average profitability margin for qualifying hospitals receives a profit factor of 1.1. All other qualifying hospitals receive a profit factor of 1.0.
(d) The agency:
(i) Identifies from historical data considered to be complete, each individual qualifying hospital's allowed charity charges; then
(ii) Multiplies the total allowed charity charges by the hospital's ratio of costs-to-charges (RCC), limiting the RCC to a value of 1, to determine the hospital's charity costs; then
(iii) Multiplies the hospital's charity costs by the hospital's profit factor assigned in (c) of this subsection to identify a revised cost amount; then
(iv) Determines the hospital's percentage of revised costs by dividing its revised cost amount by the sum of the revised charity cost amounts for all qualifying hospitals during the same period.
(4) The agency's SRIADSH payments to a hospital may not exceed one hundred percent of the projected cost of care for medicaid clients and uninsured indigent patients for that hospital unless an exception is required by federal statute or regulation. The agency reallocates dollars as defined in the state plan.
[Statutory Authority: RCW 41.05.021
. WSR 15-18-065, § 182-550-5210, filed 8/27/15, effective 9/27/15. WSR 11-14-075, recodified as § 182-550-5210, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
, and 74.09.730
(2). WSR 10-17-095, § 388-550-5210, filed 8/17/10, effective 9/17/10. Statutory Authority: RCW 74.08.090
. WSR 07-14-090, § 388-550-5210, filed 6/29/07, effective 8/1/07; WSR 06-08-046, § 388-550-5210, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050
. WSR 05-12-132, § 388-550-5210, filed 6/1/05, effective 7/1/05. Statutory Authority: RCW 74.08.090
, and 2003 1st sp.s. c 25. WSR 04-12-044, § 388-550-5210, filed 5/28/04, effective 7/1/04.]