Page 1 of 8PrintFriendly VersionPage 2 of 8What146s ChangedFor FY 2021 CMS calculated uncompensated care payments for eligible hospitals using audited Worksheet S10 data from FY 2017 cost reports Ho ID: 886110
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1 Page 1 of 8 Medicare Disproportionate Sh
Page 1 of 8 Medicare Disproportionate Share HospitalMLN006741 March 2021 Print-Friendly Version Page 2 of 8 What’s Changed? For FY 2021, CMS calculated uncompensated care payments for eligible hospitals using audited Worksheet S-10 data from FY 2017 cost reports. However, for Indian Health Service (IHS) or Tribal Hospitals and Puerto Rico hospitals, CMS based its calculation on low-income insured proxy days. For FY 2022 and subsequent FYs, except for IHS or Tribal hospitals and Puerto Rico hospitals, CMS will calculate each hospital’s
2 uncompensated care payments using the mo
uncompensated care payments using the most recent available single year of audited Worksheet-10 data.You’ll �nd substantive content updates in dark red font. Page 3 of 8 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) Provisions Impacting Helpful Websites & Regional O�ce Rural Health CoordinatorsSSA Section 1886(d)(5)(F)Qualifying for the Medicare DSH Adjustmentdisproportionate number of low-income patients, based on the hospital’s Disproportionate Patient Percentage (DPP).The DPP equals the
3 sum of the percentage of Medicare inpati
sum of the percentage of Medicare inpatient days (including Medicare A and patient days when patients exhaust their Part A bene�ts), and the percentage of total inpatient days attributable to If a hospital’s DPP equals or exceeds a speci�ed threshold amount, the hospital quali�es for the Medicare DSH adjustment. The Medicare DSH adjustment is determined by using a complex formula (the applicable formula is based on a hospital’s DPP). Page 4 of 8 Medicare DPP = Medicare Supplemental Security Income Days
4 Total Medicare Days Total Patie
Total Medicare Days Total Patient Days Figure 1. Medicare DPP Formula2. Alternate Special Exception MethodWe call these “Pickle” hospitals. If a hospital quali�es under this method, it’s eligible for a speci�c MMA Provisions Impacting Medicare DSHsThe MMA imposed a 12% DSH payment adjustment cap for certain hospitals, and exempts hospitals Since FY 2014, hospitals that are eligible for DSH payments under SSA Section 1886(d)(5)(F)SSA Section 1886(d)(5)(F)point for FYs 2018 and 2019). For FY 2020 and after,
5 there is no additional reduction.A hosp
there is no additional reduction.A hospital’s uncompensated care amount relative to the uncompensated care amount of all Worksheet S-10 data from FY 2017 cost reports. However, for Indian Health Service (IHS) or Tribal For FY 2022 and subsequent FYs, except for IHS or Tribal hospitals and Puerto Rico hospitals, CMS will calculate each hospital’s uncompensated care payments using the most recent available single year of audited Worksheet-10 data.the Acute Care Hospital IPPS and does not include patient days associated with beds in: Page 6
6 of 8 Medicare DSH Payment: Adjustment F
of 8 Medicare DSH Payment: Adjustment FormulasA hospital is eligible for a Medicare DSH payment under the primary qualifying method when its DPP meets or exceeds 15%.Medicare DSH Payment Adjustment Formulas for Hospitals Qualifying Under the Primary Status/LocationNumber of BedsThresholdAdjustment FormulaUrban Hospitals Not to Exceed 12%Urban Hospitals Not to Exceed 12%Urban Hospitals No CapUrban Hospitals No CapRural Referral Centers No CapRural Referral Centers No CapOther Rural Hospitals Not to Exceed 12%Other Rural Hospitals Not to Exce
7 ed 12%Other Rural Hospitals No CapOther
ed 12%Other Rural Hospitals No CapOther Rural Hospitals No Cap Page 7 of 8 A has 62 beds and is in an urban area. It had 5,000 total patient days, 1,000 Medicaid/non-Medicare days, 2,000 Medicare Part A days, and 300 Medicare Part A/SSI days. Hospital A’s Medicare DPP is 35%. Medicare DPP = 300 Medicare Supplemental 2,000 Total Medicare Days 5,000 Total Patient Days = .35 Figure 2. Medicare DPP Calculation & Corresponding Payment Adjustment Calculation Under Hospital A’s Medicare DSH adjustment is 12%. DSHs may also qualify for a
8 low-volume hospital Page 8 of 8 Resourc
low-volume hospital Page 8 of 8 Resources Rural Providers Helpful WebsitesAmerican Hospital Association Rural Health CareNational Association of Rural Health ClinicsNational Rural Health Associationpolicy, and operational help on rural health issues. Medicare Learning Network® Content Disclaimer, Product Disclaimer, and Department of Health & Human Services Disclosure are registered trademarks of the U.S. Department MLN Medicare Disproportionate Share HospitalMLN006741 March 2021 MLN Medicare Disproportionate Share HospitalMLN006741 March