Medicaid Hospital Reimbursement

Laws/Regulations

Quick Links:
Hospital Medicaid State Plan Amendment (SPA)
Disproportionate Share Hospital (DSH) Audit


Hospital Medicaid State Plan Amendment (SPA)

Pending Hospital Medicaid State Plans

SPA 17-0021 / 17-Z Outpatient Supplemental Payments State-Owned Acute Care Hospitals
SPA 17-0023 / 17-R Inpatient Hospital Supplemental Payments
SPA 17-0024 / 17-S Inpatient Small Hospital Pool Supplemental Payments
SPA 18-0001 Inpatient Hospital Rate Increase and Mid-Sized Hospital Supplemental Payments
SPA 18-0002 Outpatient Hospital Rate Increase and Supplemental Payments

Approved Hospital Medicaid State Plans

2017
SPA 17-011 / 17-J Modernization of Inpatient Hospital Reimbursement Methodology
SPA 17-012 / 17-K Reimbursement Update Outpatient Hospital Services

2016
SPA 16-001 Inpatient Reimbursement to Acute Care Hospitals
SPA 16-008 Hospital Reimbursement for Long Acting Reversible Contraceptive
SPA 16-013 Inpatient Supplemental Payments to Acute Care Hospitals
SPA 16-0016A Modernization Outpatient Reimbursement Methodology
SPA 16-018 Supplemental Reimbursement for Inpatient Hospital Services
SPA 16-019 Inpatient Supplemental Reimbursement to Small Independent Hospitals

2015
SPA 15-003 Acute Care Hospitals – Modernization of Inpatient Reimbursement Methodology
SPA 15-018 Outpatient Hospital Services - Fixed Fees
SPA 15-034 Outpatient Hospital Services Electroconvulsive Therapy
SPA 15-042 Inpatient Supplemental Payments to Small Acute Care Hospitals

2014
SPA 14-010 Inpatient Hospital Rates
SPA 14-013 Provider-Based Status for Outpatient Children's Hospitals - Withdrawal Letter
SPA 14-032 Acute Care Hospital Rates - Merger of Danbury and New Milford Hospitals
SPA 14-035 Outpatient Hospital Group Counseling for Tobacco Cessation

2013
SPA 13-011 Elimination of Child Psychiatric Performance Pool
SPA 13-012 Inpatient Supplemental Payments
SPA 13-029 Inpatient Supplemental Payments
SPA 13-035 Inpatient Hospital Rates
SPA 13-037 Disproportionate Share Hospital
SPA 13-046 Chronic Disease Hospitals

2012
SPA 12-002 Inpatient Hospital Rate Meld
SPA 12-005 Outpatient Supplemental Payments
SPA 12-021 Yale Merger with Saint Raphael

2011
SPA 11-012 DSH Payments
SPA 11-013 Inpatient Supplemental Payments
SPA 11-031 Inpatient Hospital Rates
SPA 11-033 Payment Adjustment for Provider Preventable Conditions



Disproportionate Share Hospital (DSH) Audit

Section 1923 of the Social Security Act, as amended, requires States to make additional Medicaid disproportionate share hospital (DSH) payments to hospitals that serve disproportionately large numbers of low-income patients. The Omnibus Budget Reconciliation Act of 1993 limits these payments to a hospital's uncompensated care costs, which are the annual costs incurred to provide services to Medicaid and uninsured patients less payments received for these patients. This limit is known as the hospital-specific DSH limit. In addition, a Centers for Medicare and Medicaid Services (CMS) letter to State Medicaid Directors (1994 CMS letter) stated that the cost of services included in a hospital's DSH limit could not exceed the amount that would be allowable under Medicare principles of cost reimbursement.

New reporting and audit requirements (DSH Audit) were implemented in the December 19, 2008 Medicaid Disproportionate Share Hospital final rule (73 Federal Register 77904). The final rule implements Section 1001 of the Medicare Drug Improvement and Modernization Act of 2003, requiring State reports and audits to ensure the appropriate use of Medicaid DSH payments and compliance with the statutorily imposed hospital-specific limits.

On December 3, 2014, CMS issued the final rule that broadened the definition of DSH uncompensated care costs starting with the FFY 2011 audit. CMS ruled that the definition of uninsured care apply to services that may not be covered by individuals who do have insurance. Hospitals can include uncompensated care costs that are service-specific as part of the DSH payments.

Federal Regulations of the Definition for DSH Uncompensated Care

DSH Audit Reports
2009 DSH Audit Report
2009 DSH Audit Numbers

2010 DSH Audit Report
2010 DSH Audit Numbers

2011 DSH Audit Report
2011 DSH Audit Numbers
2011 DSH Audit Report Addendum
2011 DSH Audit Numbers Addendum

2012 DSH Audit Report
2012 DSH Audit Numbers
2012 DSH Audit Report Addendum #1
2012 DSH Audit Numbers Addendum #1
2012 DSH Audit Report Addendum #2
2012 DSH Audit Numbers Addendum #2

2013 DSH Audit Report
2013 DSH Audit Numbers
2013 DSH Audit Report Addendum
2013 DSH Audit Numbers Addendum

2014 DSH Audit Report
2014 DSH Audit Numbers