Subpart 1.
Eligibility for
disproportionate population adjustment.
To be eligible for a disproportionate population adjustment,
a Minnesota or local trade area hospital must meet the requirements of item B
under general assistance medical care and item A and item C, D, or E under
medical assistance.
A. The hospital,
at the time that an admission occurs, must have at least two obstetricians with
staff privileges who provide obstetric services to medical assistance patients.
For nonmetropolitan statistical area hospitals, an obstetrician may be any
physician with staff privileges at the hospital to perform nonemergency
obstetrics procedures. This requirement does not apply to hospitals where the
majority of admissions are predominately individuals under 18 years of age or
hospitals that did not offer nonemergency obstetric services as of December 21,
1987.
B. The hospital has a base
year days utilization rate of medical assistance inpatient days, including
medical assistance inpatient days with another state but excluding general
assistance medical care and Medicare crossovers, divided by total inpatient
days that exceeds the arithmetic mean plus one standard deviation for Minnesota
and local trade area hospitals. The difference is added to one and rounded to
four decimal places.
C. The
hospital has a base year days utilization rate of medical assistance inpatient
days, including medical assistance inpatient days with another state but
excluding general assistance medical care and Medicare crossovers, divided by
total inpatient days that exceeds the arithmetic mean for Minnesota and local
trade area hospitals. The difference is added to one and rounded to four
decimal places.
D. The hospital has
a base year days utilization rate of medical assistance inpatient days,
including medical assistance inpatient days with another state but excluding
general assistance medical care and Medicare crossovers, divided by total
inpatient days that exceeds the arithmetic mean plus one standard deviation for
Minnesota and local trade area hospitals. The difference is multiplied by 1.1
and added to one and rounded to four decimal places.
E. The hospital has a base year low-income
utilization rate that exceeds 0.25. This rate is calculated by dividing medical
assistance revenues, including medical assistance revenues with another state
but excluding general assistance medical care, plus any cash subsidies received
by the hospital directly from state and local government by total revenues plus
the cash subsidies amount. This rate is added to the quotient of inpatient
"charity care" charges minus the cash subsidies divided by total inpatient
charges. The result is added to one and rounded to four decimal places. For
purposes of this part, "charity care" is care provided to individuals who have
no source of payment from third-party or personal resources.
Subp. 2.
Days utilization
rate used in cases where hospital qualifies under two rates.
If a hospital qualifies under both the days utilization rate
at subpart
1, item C or D, and the
low-income utilization rate at subpart
1, item E, the
disproportionate population adjustment amount shall be the days utilization
rate.
