Medicare Uncompensated Care Payment Final Rule

$179 / year

This dataset shows section 3133 of the Affordable Care Act as it amends the Medicare Disproportionate Share Hospital (DSH) adjustment provision under section 1886(d) (5) (F) of the Act, and establishes 1886(r) which provides for an additional payment for a hospital’s uncompensated care. As proposed in the FY 2014 IPPS proposed rule, the regulations that implement this provision are in proposed subpart I of 42 CFR part §412.106.

Complexity

Additional Payment for Uncompensated Care: The remainder, equal to 75 percent of what otherwise would have been paid as Medicare DSH will become available for an uncompensated care payments after the amount is reduced for changes in the percentage of individuals that are uninsured. Each Medicare DSH hospital will receive an uncompensated care payment based on its share of insured low income days (that is, the sum of Medicaid days and Medicare SSI days) reported by Medicare DSH hospitals. Changes to the Medicare DSH Payment: Effective for discharges occurring on or after FY 2014, hospitals will receive 25 percent of the amount they previously would have received under the current statutory formula for Medicare DSH.

Date Created

2015

Last Modified

2020-05-29

Version

2020-05-29

Update Frequency

Irregular

Temporal Coverage

NA

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

NA

Source Citation

NA

Keywords

Medicare Uncompensated Care Payment Final Rule, Medicare Uncompensated Care Payment, Medicare Uncompensated Payment Factor 3

Other Titles

Uncopensated Care Payment Factor 3, DSH Payment

NameDescriptionTypeConstraints
CMS_Certification_NumberCMS Certification Numberstring-
Factor_3Factor 3 is the proportion of the uncompensated care amount that a DSH hospital will receive under Section 3133 of the Affordable Care Act. A hospitals' Factor 3 for FY 2017 is the average of three individual Factor 3's based on the estimated number of Medicaid days and Medicare SSI days relative to all DSH hospitals' estimated Medicaid days and Medicare SSI days for hospitals' FY 2011, FY 2012, and FY 2013 cost reporting periods and Medicare SSI days from the FY 2012, FY2013, and FY 2014 SSI ratiosnumberlevel : Nominal
Projected_To_Receive_DSH'YES' indicates that hospital is projected to receive DSH for FY 2017, thus eligible to receive the additional payment for uncompensated care. 'NO' indicates that hospital is not projected to receive DSH for FY 2017, and thus is ineligible to receive the additional payment for uncompensated care. 'SCH' indicates that the Sole Community Hospital (SCH) is projected to be eligible for DSH (with a DPP greater than 15%) but projected to be paid under its hospital specific rate, not federal rate, thus projected not to be paid DSH and ineligible to receive the additional payment for uncompensated care.string-
CMS Certification NumberFactor 3Projected To Receive DSH
100010.000634684YES
100050.000350603YES
100060.00026234YES
100074.0991999999999996e-05YES
100081.9493e-05YES
100110.0007878389999999999YES
100128.6089e-05SCH
100160.000334145YES
100182.5878000000000002e-05NO
100190.000281335YES