Provider Notice issued 02/02/15

Important Information Regarding the Increase to Hospital Access Payments for ACA Population

The Department of Healthcare and Family Services (HFS) was granted approval by CMS to increase the current Hospital Access Payments to account for those persons that are newly eligible under the Affordable Care Act (ACA). 

Calculation of Monthly Payments

On a quarterly basis, HFS will determine the overall percentage increase to the fee-for-service (FFS) Medicaid program hospital expenditures due to the newly eligible ACA population.  This percentage will be calculated on both the inpatient and institutional outpatient services separately:

Total FFS Inpatient Claim Payments (ACA ONLY)  __________ = Inpatient %

Total FFS Inpatient Claim Payments (Title 19 excluding ACA)

Total FFS Outpatient Claim Payments (ACA ONLY)  _________ = Outpatient %

Total FFS Outpatient Claim Payments (Title 19 excluding ACA)

To determine the quarterly inpatient and outpatient aggregate amounts, the percentages above will be multiplied by the corresponding inpatient or outpatient total dollar amounts of FFS Hospital Access Payments that were paid to hospitals during that quarter.  

The aggregate amounts will then be allocated to the hospitals based on the percentage of each hospital’s inpatient or outpatient Hospital Access Payments to the total aggregate inpatient or outpatient Hospital Access Payments paid to all hospitals.  For example, if Hospital A’s inpatient Hospital Access Payments accounts for 3% of the total inpatient Hospital Access Payments, then Hospital A will be allocated 3% of the inpatient aggregate amount.  The amount of Hospital Access Payments used to determine distribution will not change month to month.

Each hospital’s quarterly allocation will be divided by three to establish monthly payment amounts and payments will coincide with the regularly scheduled FFS hospital access payments that are paid by the 7th business day of each month.

Timing

As the calculations are based on updated payment information, they cannot be determined until after each quarter ends.  Therefore, the first payment for the preceding quarter will occur the 7th business day of the second month of the quarter.  For example: the calculations for the first quarter’s percentages (March – June 2014) would occur in July, 2014.  The first monthly payment would be scheduled for the 7th business day of August, 2014 with the remaining two months payments to be paid in September and October.  Subsequent calculation and payment timelines can be seen in the chart below: 

Since the effective date of the state plan amendment was for dates of service on and after March 1, 2014, the first quarter’s determination will include March – June.  All other quarters will be based on

three-month time periods.  Because approval was granted after several of the payment due dates, HFS will be paying those payments that were due in August through January, along with the February payment, by February 10th.  There will be two checks issued per hospital if appropriate, one each for inpatient and outpatient.  A breakdown of each month’s calculations and payments by hospital will be posted at the Hospitals ACA Access Payments website: 

This site will be updated each quarter with new calculations and payment amounts.

James M. Parker, Acting Administrator

Division of Medical Programs