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ANTHONY
A. WILLIAMS
MAYOR
July 13, 2001
Honorable Linda W. Cropp
Chairman
Council of the District of Columbia
441 4`h Street. N.W.. Suite 704
Washington, DC 20001
Dear Chairman Cropp:
Enclosed for consideration and approval by the
Council is the "Medicaid State Plan Amendment for Disproportionate
Share Hospitals and Expansion of Medical Assistance Approval Resolution of
2001". In accordance with section 1(a) of An Act to enable the
District of Columbia to receive federal financial assistance under title
XIX of the Social Security Act for a medical assistance program and for
other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Code
§I-359(a)), the Mayor may submit a plan for medical assistance (State
Plan), and modifications thereof, to the Secretary of Health and Human
Services. Pursuant to section 2205 of the Service Improvement and Fiscal
Year 2000 Budget Support Act of 1999, effective October 20, 1999 (D.C. Law
13-38) the State Plan, and any modification or waiver thereof, must be
submitted to the Council for approval.
The proposed amendments would modify the existing
State Plan in two ways. First, on April 30, 2001, the District of Columbia
Financial Responsibility and Management Assistance Authority (Authority)
enacted the Health Care Privatization Emergency Amendment Act of 2001
(Act) as well as temporary and permanent legislation on the same subject.
The Act authorizes the implementation of an alternative publicly-financed
health care delivery system to replace the health care services formerly
provided by the Public Benefit Corporation (PBC). The Act also authorizes
the Mayor to contract out any of the health care services provided by the
PBC, including those provided by D.C. General Hospital. On April 30, 2001,
the Authority also issued a Resolution and Order pursuant to section 207
(c) of the District of Columbia Financial Responsibility and Management
Assistance Act, approved April 17, 1995 (109 Stat. 97; D.C. Code
§47-392.7 (c)) (April 30th Order) concerning the transition to the new
health care system. Paragraph 8 of the April 30th Order directed the
Department of Health to issue an amendment to the State Plan to transfer
the disproportionate share allotment currently received by D.C. General
Hospital to Greater Southeast Community Hospital, effective October 1,
2001, "for the purposes of providing compensation for services to
uninsured District residents provided under the contract with the
Authority." The attached proposed amendment to the State Plan
complies with the Authority's April 30`x' Order by designating the payment
of approximately $5.6 million dollars to the hospital designated as the
contractor to provide inpatient hospital services and coordinated health
care for the uninsured population of the District of Columbia under the
D.C. Healthcare Alliance. The formula for computing the payment adjustment
to private hospitals is not changed. The total amount of the
disproportionate share allotment available for distribution to all
qualifying hospitals is approximately $47 million dollars.
Further, on March 7, 2002. the Council introduced
Bill 13-637 (now D.C. Act 13-569), the "Health Care Expansion Act of
2000", for the purpose of expanding medical assistance to uninsured
persons. D.C. Act 13569 is still pending before the Authority due to an
insufficient fiscal impact statement. However, the proposed amendment
would accomplish the intent of D.C. Act 13-569 by reducing the amount of
the disproportionate share allotment available for distribution to
qualifying hospitals to fund the expansion of medical assistance to
uninsured persons, beginning in fiscal year 2002, in an amount of
approximately $12.8 million dollars.
Approval of this State Plan amendment is an integral
part of the District's overall program for protecting and improving the
delivery of health care services to our poor and vulnerable populations.
I urge you to take prompt and favorable action on
the enclosed legislation.
Sincerely,
Anthony A. Williams
Enclosure
AAW/scj
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Chairman Linda W. Cropp at the request of the Mayor
A PROPOSED RESOLUTION IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
To approve an amendment to the District of Columbia State Plan for
Medical Assistance, to change the methodology, beginning October 1,
2001, for computing the payment adjustment to hospitals that qualify
as disproportionate share hospitals, and to expand medical assistance
to uninsured persons.
RESOLVED BY THE COUNCIL OF THE DISTRICT OF
COLUMBIA, that this resolution may be cited as the "Medicaid
State Plan Amendment for Disproportionate Share Hospitals and
Expansion of Medical Assistance Approval Resolution of 2001".
Sec. 2. Pursuant to section 1(a) of An Act to enable the District of
Columbia to receive federal financial assistance under title XIX of
the Social Security Act for a medical assistance program and for other
purposes, approved December 27, 1967 (81 Stat. 774; D.C. Code §
1359(a)), the Council of the District of Columbia approves the
proposed (attached) amendment to the District of Columbia State Plan
for Medical Assistance to change the methodology, beginning October 1,
2001, for computing the payment adjustments to hospitals that qualify
as disproportionate share hospitals, and to expand medical assistance
to uninsured persons.
Sec. 3. The Secretary of the Council of the District of Columbia shall
transmit a copy of this resolution upon its adoption each to the Director of the
Department of Health and to the Mayor.
See. 4. The Council adopts the fiscal impact statement submitted in
conjunction with this resolution.
Sec. 5. This resolution shall take effect immediately.
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GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health
Medical Assistance Administration
Office of the Senior Deputy Director
825 North Capitol Street, N.E., Washington, D.C. 20002 (202) 442-5988
May 15, 2001
Mr. Ted Gallagher
Chief, Quality Performance Management Branch
Health Care Financing Administration
Division -7. of Medicaid & State Operations
Suite 2 16 The Public Ledger Building
150 South Independence Mall West
Philadelphia, PA 19106
Dear Mr. Gallagher:
Enclosed are materials for State Plan Amendment #01-03 (Safety Net DSH
Modification), which proposes to modify the existing DSH language to allow
support for local initiatives to expand care for those previously
uninsured persons. If approved, the SPA would be effective October 1,
2001. This proposed amendment is subject to approval of the Council of the
District of Columbia (Council) and could be withdrawn or modified after
Council review.
As you may be aware, the District of Columbia has decided to phase out the
inpatient care and trauma center services at D.C. General Hospital, and
contract with a local private-sector provider for these services, while
expanding access through a community-based provider network. Approval of
this proposed SPA is an integral part of the District's overall program
for protecting and improving the delivery of services to poor and
vulnerable populations.
If you or your staff should require additional information or
clarification on our proposal to revise the DSH methodology, please
contact Dr. LaRah Payne, Medicaid Policy Analyst, at 202-442-9116.
Sincerely,
Herbert H. Weldon, Jr.
Senior Deputy Director
Enclosures
cc: LaRah D. Payne, ScD
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TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL
FOR: HEALTH CARE FINANCING ADMINISTRATION
TO:
REGIONAL ADMINISTRATOR
HEALTH CARE FINANCING ADMINISTRATION
DEPARTMENT OF H EALTH AND HUMAN SERVICES
1. TRANSMITTAL NUMBER 01-03
2. STATE: Washington, D.C.
3. PROGRAM IDENTIFICATION: TITLE XIX OF THE SOCIAL SECURITY ACT (MEDICAID)
4. PROPOSED EFFECTIVE DATE: October 1, 2001
5. TYPE OF PLAN MATERIAL: AMENDMENT
COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT (Separate Transmittal
for each amendment)
6. FEDERAL STATUTE/REGULATION CITATION: Section 1923(c)
Social Security Act; 42 CFR 447 Subpart E
7. FEDERAL BUDGET IMPACT:
a. FFY 2001, $_____;
b. FFY 2002 $_____
8. PAGE NUMBER OF THE PLAN
SECTION OR ATTACHMENT: Attachment 4.19A page 20, 20a, 20b
9. PAGE NUMBER OF THE SUPERSEDED PLAN SECTION OR ATTACHMENT (If Applicable):
Attachment 4.19A Page 20,20a, TN# 97-09
10. SUBJECT OF AMENDMENT: DSH Modification (Safetynet)
11. GOVERNOR'S REVIEW (Check One): ___GOVERNOR'S OFFICE REPORTED NO COMMENT,
___ COMMENTS OF GOVERNOR'S OFFICE ENCLOSED ___ NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL,
___ OTHER, AS SPECIFIED:
12. SIGNATURE OF STATE AGENCY OFFICIAL: Herbert H. Weldon, Jr.
13: TYPED NAME: Herbert H. Weldon, Jr.
14. TITLE: Senior Deputy Director for Health Care Finance
15. DATE SUBMITTED:
16. RETURN TO:
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h. Under authority of 1923(c)(3), the District of Columbia may limit the
total DSH payments that it will make to hospitals that qualify as
disproportionate share hospitals in fiscal years 2002 and each fiscal
year thereafter to the following amount: the Federal annual DSH
allotment for the District of Columbia, expressed in total computable
dollars, for that fiscal year less $12,857,142. Total computable dollars
is the total Medicaid DSH payments, including the federal and District
share of financial participation. This District established limit shall
be referred to in this State Plan as the "annual District DSH
limit" to distinguish it from the annual Federal DSH allotment for
the District.
i. The following applies to disproportionate payment adjustments to
hospitals effective October 1, 2001:
(1) All hospitals, which meet the disproportionate share hospital (DSH)
eligibility criteria in section 10.a. of this Plan, shall be paid in accordance
with section 10.1.(2) of this Plan. Each qualifying hospital shall also meet the
requirements set forth in sections 10.c through 10.e of this Plan.
(2) Effective October 1, 2001, and in accordance with section 1923(c)(3)
of the Social Security Act, the District of Columbia Medicaid Program shall
establish three categories of hospitals to pay each hospital that qualifies as a
disproportionate share hospital (DSH):
(a) The first category shall include the hospital designated as the
contractor to provide inpatient hospital services and coordinated health care
for the uninsured population of the District of Columbia under the D.C.
Healthcare Alliance. The second category shall include the public psychiatric
hospital, which is St. Elizabeth's Hospital. The third category shall
include any qualifying private hospital.
(b) The payment adjustment for each qualifying DSH hospital shall be
computed as follows:
(i) Five million, six hundred thirty six thousand ,five hundred
seventy one dollars ($5,636,571) shall be paid to the hospital
designated as the contractor to provide inpatient hospital services and coordinated
health care for the uninsured population of the District of Columbia
under the D.C. Healthcare Alliance Program.
(ii) The difference between the annual District DSH limit as defined in section l0h, and the amount paid to the hospital designated as the
contractor to provide inpatient hospital services and coordinated health care services for the uninsured population of the District of
Columbia under the D.C. Healthcare Alliance Program, as computed in subsection 10.i.(2)(b)(i), shall be distributed as follows:
A. Each public psychiatric qualifying DSH hospital shall be paid an amount based upon the formula set forth in section
(1923(c)(1) of the Social Security Act, which is the product of the amount established under section 1923(c)(1)(A) times
the adjustment percentage established under section
1886(d)(5)(F)(iv).
B. Each private qualifying DSH hospital shall be paid an amount based upon the formula set forth in section
(1923(c)(1) of the Social Security Act, which is the product of the amount established under section 1923(c)(1)(A) times
the adjustment percentage established under section
1886(d)(5)(F)(iv).
j. Any payment adjustment computed in accordance with subsection
l0i(2)(b) is subject to the limit on payments to individual hospitals
established by section 1923(g) of the Social Security Act. The amount of
any payment that would have been made to any hospital, but for the limit
on payments established by section 1923(g), shall be distributed
proportionately among the remaining qualifying hospitals in the second
and third categories, based on the ratio of the hospital's
hospital-specific payment adjustment to the aggregate DSH payment
adjustment for all hospitals.
k. Any DSH payment adjustments computed in accordance with section
l0i(2)(b) of this Plan are subject to the limits on payments to Institutions for
Mental Disease (IMD) established by section 1923(h) of the Social Security
Act. The amount of any payment that would have been made to a public or
private hospital, but for the limit on payments established by section
1923(h), shall be distributed proportionately among the remaining
qualifying hospitals in the second and third categories, based on the
ratio of the hospital's hospital-specific payment adjustment to the
aggregate DSH payment adjustment for all hospitals.
l. If, during any fiscal year, the District of Columbia's total
allotment is not sufficient to pay the full amount of any DSH payment
adjustment computed in accordance with section 101(2)(b) of this Plan,
then each hospital in the second and third categories shall be paid a
proportional amount of the allotment, based on the ratio of the
hospital's hospital-specific payment adjustment to the aggregate DSH
payment adjustment for all hospitals.
11. All claims for inpatient services are settled in accordance with the
D.C. State Plan and federal laws and regulations in effect on the date of service.
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