205.637 Enhanced Medicaid payments to county-owned or operated hospitals --
544 words·~2 min read·
/ky/205-637A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Payments to other hospitals.
(a)A county-owned or operated hospital shall receive an enhanced Medicaid
payment in an amount, calculated from the most recent cost report filed by
that hospital with the department as of June 30 of each year, equal to the
difference between the amount of total payments made to the hospital by the
department or a managed care entity for covered services provided to
Medicaid beneficiaries, including services attributable to recipients in
Medicaid managed care programs, during the state fiscal year and the
hospital's cost for the services determined by the department under Medicare
payment principles. Reimbursement under this section shall be made in a
single payment. From July 1 through August 1 of each year, the Department
for Medicaid Services shall calculate the payment due to be made to each
county-owned or operated hospital and shall make the payment to each
hospital no later than August 15 of each state fiscal year. The department shall
make an enhanced payment to each county-owned or operated hospital in state
fiscal year 1998 using cost reports filed with the department on or before June
30, 1998, for the hospitals' latest fiscal year.
(b)A payment described in this section is not due to a county-owned or operated
hospital unless an intergovernmental transfer is made. A county-owned or
operated hospital may make an intergovernmental transfer, or an
intergovernmental transfer may be made on behalf of the hospital by a county,
budget unit of a county governmental agency, or lending institution if it is not
prohibited by state or federal law.
(c)An intergovernmental transfer shall be made to the enhanced Medicaid
payment fund by August 2 of each state fiscal year in an amount equal to
eighty percent (80%) of the amount determined under paragraph
(a)of this
subsection and shall be matched with federal funds.
(d)An enhanced Medicaid payment shall be made to each county-owned or
operated hospital participating in the intergovernmental transfer program in an
amount equal to one hundred percent (100%) of the hospital's Medicaid
shortfall as determined under paragraph
(a)of this subsection.
(e)The department shall determine the Medicaid shortfall for all other hospitals
that are not county-owned or operated or are not state-university-owned or
operated hospitals, which shall be equal to the difference between total
payments made by the department or a managed care entity for covered
services provided to Medicaid beneficiaries, including those enrolled in
managed care, during the state fiscal year and the hospital's costs for the
services as determined by the department under Medicare payment principles.
Funds remaining from the enhanced Medicaid program shall be distributed to
each hospital which is not county-owned or operated or is not state-university-
owned or operated on a pro rata basis. If funds remain in the enhanced
Medicaid payment fund after making enhanced Medicaid payments required
by this subsection, the remaining funds shall be available for use by the
department for funding the regular Medicaid program.
(2)The enhanced Medicaid payment authorized under subsection
(1)of this section
shall not be implemented as part of the disproportionate share hospital program or if
federal financial participation is not available.
(3)The Cabinet for Health and Family Services shall promulgate administrative
regulations to implement the provisions of this section.