Hospitals That Are Excluded From Medicare Acute Care PPS (such As Children's Hospitals) Are Paid Based On?
Reasonable costs
Hospitals that are excluded from Medicare Acute Care PPS, such as children's hospitals, are paid based on a different reimbursement system called the Medicaid Disproportionate Share Hospital (DSH) program.
To understand how children's hospitals are paid under the Medicaid DSH program, you can follow these steps:
1. Research the Medicaid Disproportionate Share Hospital (DSH) program: The first step is to gather information about the Medicaid DSH program. This program provides additional funding to hospitals that serve a large number of low-income and uninsured patients. It aims to help these hospitals offset the costs of uncompensated care.
2. Identify the criteria for DSH eligibility: Children's hospitals and other providers classified as disproportionate share hospitals may be eligible to receive DSH payments. The eligibility criteria vary by state, so it is important to check the specific guidelines of the state in question.
3. Determine the payment calculation: The Medicaid DSH payments are determined based on a formula that considers the hospital's Medicaid and uninsured patient volumes, as well as the hospital's estimated costs for providing uncompensated care. The exact calculation method can vary across states.
4. Consult the Centers for Medicare and Medicaid Services (CMS): The CMS is the federal agency that manages the Medicaid program. They provide guidance and regulations for Medicaid DSH payments. Visiting the CMS website or contacting them directly can provide additional information and resources regarding DSH payments for excluded hospitals like children's hospitals.
5. Reach out to state Medicaid agencies: Every state operates its own Medicaid program, and they have specific rules and regulations regarding DSH payments. It is recommended to contact the state Medicaid agency to obtain precise information on how payments are determined for children's hospitals in that particular state.
By following these steps, you can gain a better understanding of how hospitals excluded from Medicare Acute Care PPS, such as children's hospitals, are paid based on the Medicaid DSH program.