2021 Session

Budget Amendments - SB1100 (Member Request)

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Chief Patron: Barker
Modify Methodology for Hospital Provider Payments (language only)

Item 3-5.16 #1s

Item 3-5.16 #1s

Adjustments and Modifications to Tax Collections
Provider Payment Rate Assessment


Page 662, line 51, after "Equivalent to", insert "(i)".

Page 662, line 52, before "subject to CMS", insert:

"or (ii) the maximum managed care directed payment amount as allowed by CMS,".


(This amendment modifies language related to the hospital provider payment rate assessment to change the methodology to enable the hospitals to obtain additional federal dollars with no additional cost to the Commonwealth. Current budget language limits supplemental payments by the upper payment limit gap for fee-for-service claims and extrapolates that gap to managed care claims. Because over 90 percent of Medicaid enrollees are in managed care, this gap can be highly variable on an annual basis and can limit total rate enhancement. The federal Centers for Medicare and Medicaid (CMS) has provided other states the flexibility to structure managed care directed payments as a percentage of Medicare. However, the current budget language is highly prescriptive and limits the department's ability to explore and apply an alternate methodology which could potentially stabilize or increase total supplemental payments.)