Section 17-312-107 - Disproportionate share adjustmentFor purposes of this regulation, the following definitions apply:
(a)Definitions(1) "Medicaid inpatient utilization"-For a hospital, the total number of its Medicaid inpatient days including newborn in a cost reporting period, divided by the total number of the hospital's inpatient days including newborn in that same period.(2) "Low-income utilization rate"-For a hospital, the sum (expressed as a percentage) of the fraction, calculated as follows:(A) Total Medicaid inpatient revenues paid to the hospital, plus the amount of the cash subsidies received directly from State and local governments in a cost reporting period, divided by the total amount of revenues of the hospital for inpatient services (including the amount of such cash subsidies) in the same cost reporting period; and,(B) The total amount of the hospital's charges for inpatient hospital services attributable to charity care (care provided to individuals who have no source of payment, third-party or personal resources) in a cost reporting period, divided by the total amount of the hospital's charges for inpatient services in the hospital in the same period. The total inpatient charges attributed to charity care shall not include contractual allowances and discounts (other than for indigent patients not eligible for Medical assistance under an approved Medicaid State plan) that is, reductions in charges given to other third-party payers, such as HMOs, Medicare or Blue Cross.(b) Effective for the fiscal year ending September 30, 1989 and subsequent fiscal years hospitals which meet at least one of the following criteria shall be eligible for a disproportionate share adjustment.(1) A Medicaid inpatient utilization rate at least one standard deviation above the mean Medicaid inpatient utilization rate for hospitals receiving Medicaid payments in the State.(2) A low-income inpatient utilization rate exceeding 25 percent.(c) If the hospital meets one of the criteria in subsection (b), it must also have at least two obstetricians with staff privileges at the hospital who have agreed to provide obstetric services to individuals entitled to such services under the State Medicaid plan.(d) The Department shall determine from available Medicaid cost reports which hospitals meet the criteria of subsection (b) (1). Hospitals that believe they meet the criteria of subsection (b) (2) must file with the Department by August 1st of each year their calculation that the low-income inpatient utilization rate exceeded 25 percent for the most recently completed fiscal year.(e) In calculating interim rates pursuant to section 17-312-103 of these regulations, hospitals that qualify for a disproportionate share adjustment shall have its estimated TEFRA target amount increased by the available Medicare disproportionate share adjustment percentage as determined by the Medicare fiscal intermediary.(f) A hospital that received an adjustment as a disproportionate share hospital in its interim per diem rate shall receive in its final target rate calculated pursuant to Section 17-312-104 of these regulations the same adjustment percentage as set forth in subsection (e) above.Conn. Agencies Regs. § 17-312-107