(1) The medicaid agency's sole community disproportionate share hospital (SCDSH) program is a program for in-state hospitals that:

(a) Were certified by the Centers for Medicare and Medicaid Services (CMS) as sole community hospitals as of January 1, 2013;

(b) Had less than one hundred fifty acute care licensed beds in state fiscal year (SFY) 2011;

(d) Are not participating in the certified public expenditure (CPE) program; and

(e) Are rural hospitals in Lewis County.

(2) The agency pays qualifying hospitals SCDSH payments from a legislatively appropriated pool. This distribution is based on the hospital's medicaid payments. To determine the hospital's SCDSH payments, the agency:

(a) Identifies the sum of the medicaid payments to the individual hospital during the SFY two years prior to the current SFY for which DSH application is being made. These medicaid payment amounts:

(i) Are based on historical data;

(ii) Include payments from the agency; and

(iii) Include payments reported on encounter data supplied by agency-contracted managed care organizations.

(b) Divides the medicaid payment amount in (a) of this subsection by the sum of the medicaid payment amounts for all qualifying hospitals during the same period to determine the hospital's percentage; and

(3) The SCDSH payments to a hospital eligible under this program may not exceed the hospital's DSH cap calculated according to WAC 182-550-4900(10).

(4) SCDSH payments are subject to the availability of DSH funds under the statewide DSH cap. If the statewide DSH cap is exceeded, the agency will recoup DSH payments in the order specified in WAC 182-550-4900 (13) and (14).

PDFWAC 182-550-5380

Payment method—Sole community disproportionate share hospital (SCDSH).