SUBCHAPTER 22R - distribution of Hospital Uncompensated Care Fund
10A NCAC 22R .0101 SCOPE
This Subchapter establishes the requirements for the distribution of funds allocated to the Hospital Uncompensated Care Fund pursuant to G.S. 143C-9-9 after distributions of available funds have been made pursuant to 10A NCAC 22Q.
History Note: Authority G.S. 108A-54; 143C-9-9;
Temporary Adoption Eff. December 29, 2021;
Eff. August 1, 2022.
10A NCAC 22R .0102 DEFINITIONS
(a) "Department" means the North Carolina Department of Health and Human Services.
(b) "Eligible hospital" means an institution that meets the requirements of Rule .0103 of this Section.
(c) "Eligible hospital cost" means the values calculated pursuant to Rule .0104 of this Section.
(d) "Hospital Uncompensated Care Fund" means the fund established by G.S. 143C-9-9 and governed by 10A NCAC 22R.
(e) "Outpatient services" means the medical care and items as defined by 42 CFR 440.20(a), which is incorporated by reference in 10A NCAC 22Q .0102.
(f) "Uninsured patient" means a recipient of medical care who has no health insurance, Medicaid or Medicare, or other third-party coverage. State and local government payments made to a hospital for services provided to indigent patients shall not be considered third-party coverage.
(g) "Payment period" means the 12-month term ending September 30th of each year.
History Note: Authority G.S. 108A-54; 143C-9-9;
Temporary Adoption Eff. December 29, 2021;
Eff. August 1, 2022.
10A NCAC 22R .0103 ELIGIBLE HOSPITAL
An institution licensed by the State of North Carolina that meets the definition in G.S. 131E-176 (13) is eligible for reimbursement from the Hospital Uncompensated Care Fund if it:
(1) is not a public agency qualified to certify expenditures in accordance 42 CFR 433.51(b), which is incorporated by reference in 10A NCAC 22Q .0102;
(2) received payment for more than 50 percent of their Medicaid inpatient discharges under the North Carolina Medicaid State Plan, Attachment 4.19-A discharge Diagnosis Related Groups methodology for the most recent payment period;
(3) files with the Department 90-days prior to the date of payment under this Subchapter forms prescribed by the Department attesting to the hospital's:
(a) qualification for disproportionate share status of the "Disproportionate Share Hospital (DSH) Payment" section of the North Carolina Medicaid State Plan, Attachment 4.19-A;
(b) unreimbursed charges and payments for outpatient services provided to uninsured patients; and
(c) aggregate Medicaid outpatient cost-to-charge.
History Note: Authority G.S. 108A-54; 143C-9-9;
Temporary Adoption Eff. December 29, 2021;
Eff. August 1, 2022.
10A NCAC 22R .0104 ELIGIBLE OUTPATIENT COSTS
(a) An eligible hospital's eligible outpatient costs for uninsured patients will be determined by multiplying the hospital's outpatient cost-to-charge ratio in Rule .0103(3)(c) of this Section by the hospital's outpatient charges for uninsured patients from Rule .0103(3)(b) of this Section.
(b) From the product calculated in Paragraph (a) of this Rule, the Department will then subtract payments that the hospital received from uninsured patients for outpatient services from Rule .0103(3)(b) of this Section.
(c) The Department will bring the uncompensated care cost data forward to the end of the payment period by applying the applicable Centers for Medicare and Medicaid Services' Prospective Payment System Hospital Input Price Indices, which are incorporated by reference, including subsequent amendments and editions and available at no cost at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/MarketBasketData.
History Note: Authority G.S. 108A-54; 143C-9-9;
Temporary Adoption Eff. December 29, 2021;
Eff. August 1, 2022.
10A NCAC 22R .0105 DISTRIBUTION OF AVAILABLE FUNDS
(a) An eligible hospital satisfying the requirements of Rule .0103 of this Section shall be eligible for a payment from funds available under this Subchapter. In a payment period, an eligible hospital shall receive a proportional payment of the available funds based on the eligible hospital's share of outpatient costs for uninsured patients as a percentage of the aggregate of outpatient costs for uninsured patients for all eligible hospitals.
(b) Based on the availability of funds, payments authorized by this Rule shall be made at least annually on a frequency determined by the Department in consultation with certifying hospitals.
(c) To confirm the hospital's eligibility to receive payments pursuant to this Subchapter and the accuracy of the hospital's attestation to unreimbursed charges for outpatient services provided to uninsured patients and the hospital's Medicaid outpatient cost-to-charge ratios, the Department may audit a hospital receiving more than two million dollars ($2,000,000) for compliance with the requirements of this Subchapter. Upon completion of the audit, the following shall occur when applicable:
(1) If a hospital received payments pursuant to Paragraph (a) of this Rule in excess of the percentage determined by the audit, the excess payments shall be refunded to the Department.
(2) The Department shall distribute any refunded amounts to eligible hospitals, excluding eligible hospitals from whom excess distributions were recovered pursuant to Subparagraph (c)(1) of this Rule, within 12 months of receipt using the distribution method set forth Paragraph (a) of this Rule.
(3) No additional payment shall be made to eligible hospitals in connection with the audit except for the redistribution of amounts refunded after an audit conducted by the Division of Health Benefits.
History Note: Authority G.S. 108A-54; 143C-9-9;
Temporary Adoption Eff. December 29, 2021;
Eff. August 1, 2022.