Rate Year 2020 Determinations for DSH, MPA and CTCA Adjustment Payments

April 8, 2019

MEMORANDUM

ACTION REQUIRED – CRITICAL DUE DATES – Rate Year 2020 Determinations for DSH, MPA and CTCA Adjustment Payments

The Illinois Department of Healthcare and Family Services (HFS) has posted the rate year 2020 Determination for Disproportionate Share (DSH), Medicaid Percentage Adjustment (MPA) and County Trauma Center Adjustment (CTCA) payments in a notice on its website. Information from these determinations is also used for the Safety Net Hospital determination. The associated required forms are available for download on the HFS Cost Reports page. In an effort to increase efficiency and reduce waste, HFS is no longer sending paper notices or forms for these payments to hospitals.

The majority of the deadlines for providing the required data to HFS for the 2020 Medicaid DSH, MPA and CTCA payment determinations are July 1, 2019, with a few exceptions as outlined below. The data must be received by or postmarked by these deadlines (meter dates are not acceptable); information not received by this date will not be used in the calculation.

Hospital Data Required

Claims data

Claims data for your hospital’s fiscal year 2017 and state fiscal year 2018 (July 1, 2017 – June 30, 2018) is utilized in determining these adjustment payments. Claims that have not been adjudicated by June 30, 2019 will not be included in determinations.
Submit any outstanding claims to ensure inclusion in the rate year 2019 determinations.

Disproportionate Share Obstetrical Statement – Rate Year 2020

Deadline is July 1, 2019.
The form certifies that the hospital is providing non-emergency obstetrical services, which is a federal requirement for DSH payment adjustments eligibility unless the hospital did not provide obstetrical services on Dec. 22, 1987.

Low Income Utilization Collection Form

Deadline is July 1, 2019.
The form certifies that the hospital’s low income utilization rate (LIUR) exceeds the required 25 percent. Form submission is not required if LIUR does not exceed 25 percent.
An audited certified financial statement and, if any, all other supporting work papers must be attached.

Hospital’s 2017 Cost Report

Deadline is July 1, 2019.
No action is required if the hospital’s 2017 cost report is audited.
If the hospital’s 2017 Cost Report is unaudited, review for any inaccuracies and, if applicable, submit a corrected or amended Cost Report before the July 1, 2019 deadline.

Statements for Out-of-State Medicaid Days

Deadline is July 1, 2019.
Provide documentation from each state for out-of-state Medicaid days that you want included, and submit to the department before the deadline stated.

OBRA ’93 Data Collection Form

Deadline is Aug. 15, 2019.
Mandatory for all hospitals.
Hospital’s fiscal year 2017 information.
Used by the department to determine if it has met the federal guidelines set forth in the Omnibus Budget Reconciliation Act (OBRA) of 1993.

Since HFS has been successful in gaining denial for appeals related to these data submission requirements, it is imperative that hospitals meet the requirements in the administrative rules. You can download the Action Notice and all required forms which specify the addresses to submit all required information.