114 CMR, § 114. 40, § 40.10

Current through Register 1536, December 6, 2024

Section 40.10 - Medicaid Disproportionate Share Adjustments

The Medicaid program will assist hospitals which carry a disproportionate financial burden of caring for the uninsured and low income persons of the Commonwealth. In accordance with Title XIX rules and requirements, Medicaid will make an additional payment adjustment to hospitals which qualify for such an adjustment under any one or more of the following classifications. Eligibility requirements for each type of disproportionate share adjustment and the methodology for calculating these adjustments are described in 114.1 CMR 40.12 through 114.1 CMR 40.13.

(1) To qualify for any type of disproportionate share payment adjustment, a hospital must have a Medicaid inpatient utilization rate (calculated by dividing Medicaid patient days by total patient days) of not less than 1%.

(2) The total of all disproportionate share payments awarded to a particular hospital under 114.1 CMR 40.11 through 114.1 CMR 40.13 shall not exceed the costs incurred during the year of furnishing hospital services to individuals who either are eligible for Medicaid or have no health insurance or source of third party coverage, less payments by Medicaid and by uninsured patients.

114 CMR, § 114. 40, § 40.10