Sec. 19a-670. (Formerly Sec. 19a-169a). Disproportionate share payments to hospitals.
Sec. 19a-670. (Formerly Sec. 19a-169a). Disproportionate share payments to
hospitals. (a) Within available appropriations, the Department of Social Services may
make semimonthly payments to short-term general hospitals in an amount calculated
pursuant to section 19a-671, provided the total amount of payments made to individual
hospitals and to hospitals in the aggregate shall maximize the amount qualifying for
federal matching payments under the medical assistance program as determined by the
Department of Social Services in consultation with the Office of Policy and Management. No payments shall be made to any hospital exempt from taxation under chapter
211a. The payments shall be medical assistance disproportionate share payments, including grants provided pursuant to section 19a-168k, to the extent allowable under
federal law. The payments shall not be part of the routine medical assistance inpatient
hospital rate determined pursuant to section 17b-239. Payments shall be made on an
interim basis during each year and a final settlement shall be calculated pursuant to
section 19a-671 by the office for each hospital after the year end based on audited data
for the hospitals. The Commissioner of Social Services may withhold payment to a
hospital which is in arrears in remitting its obligations to the state.
(b) (1) For the hospital fiscal year 1994, and subsequent fiscal years, the commission or its designated representative shall conduct a cash audit of the projected amount
of uncompensated care, including emergency assistance to families and underpayments
against the actual receipts of the hospital. In addition, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days
or other measures of patient volume for hospitals for the purposes of termination and
final settlement of uncompensated care pool assessments and payments for the period
ending March 31, 1994.
(2) For the six-month period ending September 30, 1994, and for each subsequent
fiscal year, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume
for hospitals for the purposes of determining disproportionate share payments. Included
in this audit shall be a comparison of projected and actual levels of medical assistance
underpayment and uncompensated care.
(3) The total payments from the Department of Social Services medical assistance
disproportionate share-emergency assistance account established pursuant to section 38
of public act 94-9* and made in accordance with sections 19a-670 to 19a-672, inclusive,
during the fiscal year less any payments for emergency assistance to families, and less
any payments resulting from the resolution of or court order entered in any civil action
pending on April 1, 1994, in the United States District Court for the district of Connecticut, shall be reallocated to hospitals based on actual audited levels of medical assistance
underpayment, grants pursuant to section 19a-168k and uncompensated care to determine the final payment for the fiscal year.
(4) If the final payment for a hospital for the hospital fiscal year, as determined as
a result of this audit, is less than the total payments the hospital received during the
same fiscal year excluding any prior year audit adjustment, then the current hospital
fiscal year remaining semimonthly payments shall each be reduced by an amount equal
to the total excess payment divided by the number of remaining semimonthly payments
for the current hospital fiscal year.
(5) If the final payment for a hospital for the hospital fiscal year, as determined as
a result of this audit, is greater than the total payments the hospital received during the
same fiscal year, then the current hospital fiscal year remaining semimonthly payments
shall each be increased by an amount equal to the total excess payment divided by the
number of remaining semimonthly payments for the current hospital fiscal year.
(6) The office shall, by June 1, 1995, and June first of each subsequent year, report
the results of such audit for the previous hospital fiscal year to the joint standing committee of the General Assembly having cognizance of matters relating to public health.
The report shall include information concerning the financial stability of hospitals in a
competitive market.
(7) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, no adjustment of disproportionate share payments to hospitals for purposes of
final settlement shall be implemented for the hospital fiscal years commencing October
1, 1997, and October 1, 1998, provided every hospital subject to final settlement for
said fiscal years submits documentation in writing of its agreement to forego such final
settlement to the Commissioner of Social Services in a form acceptable to the commissioner.
(8) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, for the hospital fiscal year commencing October 1, 1999, and for each subsequent fiscal year, no adjustment of disproportionate share payments to hospitals for
purposes of final settlement shall be determined or implemented.
(9) For the quarter ending September 30, 2001, no negative adjustment to the disproportionate share payments to hospitals for purposes of implementing the final one-quarter of the disproportionate share final settlement for the hospital fiscal year commencing
October 1, 1998, shall be made. Any hospitals with a positive adjustment to the disproportionate share payments for purposes of implementing the remaining one-quarter of
the hospital fiscal year 1999 disproportionate share final settlement shall receive payment of the adjustment through funds appropriated for said purpose.
(10) The Department of Social Services may, within available appropriations and
with the approval of the Office of Health Care Access and the Office of Policy and
Management, make payment of any final settlement amount determined to represent
any and all claims arising out of any incorrect payments to Yale-New Haven Hospital
for the fiscal quarter ending September 30, 1998, or the hospital fiscal year ending
September 30, 1999, or both. If such incorrect payment, whether an overpayment or an
underpayment, has occurred as a result of the hospital's reporting incorrect information
and statistics to the Office of Health Care Access, the Office of Health Care Access
shall recompute the amount of any payments for the indicated time periods, offsetting
any underpaid amount by the amount of any overpayment of funds for the indicated
time period. Yale-New Haven Hospital shall submit all information and documentation
determined necessary by the Office of Health Care Access to make a final determination
of the amounts due. Prior to the release of any funds under this section, the hospital
shall submit a written release in a form satisfactory to the Secretary of the Office of
Policy and Management. The written release shall provide for settlement of any and all
claims which have been or could have been brought challenging the amount of payment
for the indicated periods. Nothing in this section shall be construed to relieve the hospital
from any settlement or adjustments for any periods other than those identified in this
section.
(c) The Commissioner of Social Services is authorized to determine exceptions,
exemptions and adjustments in accordance with 42 CFR 413.40.
(d) Nothing in section 3-114i, subdivision (2) or (29) of subsection (a) of section
12-407, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section
12-412, subdivision (1) of section 12-414, or sections 12-263a to 12-263e, inclusive,
section 19a-646, 19a-659, 19a-662 or 19a-669 to 19a-670a, inclusive, 19a-671, 19a-671a, 19a-672, 19a-672a, 19a-673 and section 19a-676, or section 1, 2, or 38 of public
act 94-9* shall be construed to require the Department of Social Services to pay out
more funds than are appropriated pursuant to said sections.
(P.A. 94-9, S. 5, 41; P.A. 95-160, S. 57, 69; 95-257, S. 39, 58; 95-306, S. 4, 7; P.A. 96-139, S. 12, 13; 96-165, S. 5, 9;
P.A. 97-2, S. 4, 8; P.A. 99-279, S. 27, 45; June Sp. Sess. P.A. 01-3, S. 3, 6; P.A. 02-89, S. 40; 02-101, S. 9; 02-103, S. 30;
P.A. 06-64, S. 16; P.A. 07-149, S. 10; P.A. 08-29, S. 3.)
*Note: Sections 1, 2 and 38 of public act 94-9 are special in nature and therefore have not been codified but remain in
full force and effect according to their terms.
History: P.A. 94-9 effective April 1, 1994; P.A. 95-160 amended Subsec. (a) to change shall to may re payments to
hospitals and added proviso re aggregate to maximize federal match, effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 95-306 amended Subsec.
(b)(3) by requiring the subtraction of payments from a court order entered in a civil action pending on April 1, 1994, in
the United States District Court for the district of Connecticut, from the total payments made from the medical assistance
disproportionate share-emergency assistance account, effective July 6, 1995; P.A. 96-139 changed effective date of P.A.
95-160 but without affecting this section; P.A. 96-165 amended Subsec. (d) to make a technical change, effective July 1,
1996; Sec. 19a-169a transferred to Sec. 19a-670 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors
editorially omitted a reference to repealed section 19a-169d from Subsec. (d)); P.A. 97-2 amended Subsec. (a) to provide
that no payment be made to children's general hospitals that are exempt from tax under chapter 211a, effective the later
of October 1, 1997, or upon the date of federal approval or federal determination that no approval is required pursuant to
Sec. 19a-670a; (Revisor's note: Actual effective date was October 1, 1997); P.A. 99-279 amended Subsec. (a) to exempt
John Dempsey Hospital of The University of Connecticut Health Center from the disproportionate share payment system,
and amended Subsec. (b)(2) to substitute "determining" for "final settlement of", and added Subsec. (b). (7) and (8) which
provide that no retroactive adjustment of disproportionate share payments to hospitals for purposes of final settlement
shall be implemented, effective July 1, 1999; June Sp. Sess. P.A. 01-3 amended Subsec. (a) by adding provision re short-term general hospitals, making a technical change and deleting provision re increase of rates to resolve civil action pending
on April 1, 1994, and added Subsec. (b)(9) and (10) re adjustment to disproportionate share payments and settlement of
claims arising out of any incorrect payments to Yale-New Haven Hospital, effective July 1, 2001; P.A. 02-89 amended
Subsec. (d) to replace reference to Sec. 19a-666 with Sec. 19a-667, reflecting the repeal of Sec. 19a-666 by the same public
act; P.A. 02-101 amended Subsec. (d) to make technical changes, effective July 1, 2002; P.A. 02-103 made technical
changes in Subsec. (d); P.A. 06-64 amended Subsec. (d) to delete references to repealed Secs. 19a-661, 19a-667, 19a-668,
19a-677 and 19a-679, effective July 1, 2006; P.A. 07-149 made technical changes in Subsec. (d); P.A. 08-29 amended
Subsec. (a) by deleting reference to emergency assistance to families program and department's authority to make payments
to hospitals for emergency assistance to needy families with dependent children, effective April 29, 2008.