PURPOSE: This rule creates enhancement pools to increase reimbursement to government-owned hospitals and all hospitals, in an amount not to exceed the Medicare Upper Limit payment for the Medicaid program.

1. (1) Medicaid Enhancement Pools. Each participating government-owned or operated hospital may be paid a one-time per year payment from an enhancement pool that shall be calculated at a percentage to be specified by the department of the aggregate difference between the Medicare Upper Limit and the per-diem reimbursement for all Medicaid hospitals for services covered by the Missouri Medicaid program.

   1. (A) The aggregate difference between the Medicare Upper Limit and the per-diem reimbursement for all Medicaid hospitals will be calculated as follows. The per-diem Medicaid rates used in the calculation will be those being paid at the time of the calculation. The Medicare Upper Limit calculation will be based on the uniform cost report for the third previous rate year, trended forward (for example, calculation for State Fiscal Year 2001 would be based on hospital cost reports ending during calendar year 1998, trended forward). The difference for each facility will then be multiplied by the Medicaid days at that particular hospital. The product of all calculations shall then be added together with the resulting sum comprising the aggregate difference between the Medicare Upper Limit and the per-diem Medicaid reimbursement for all facilities.
   2. (B) The enhancement payment shall be distributed to participating governmental hospitals based on their pro-rata share of Medicaid patient days.
   3. (C) A participating government-owned or operated hospital is one that has entered into an intergovernmental funds transfer agreement with the department.
2. (2) All Medicaid enrolled hospitals may participate in distributions from a second pool that shall be calculated at a percentage to be specified by the department of the aggregate difference between the Medicare Upper Limit and per-diem reimbursement for all Medicaid enrolled hospitals for services covered by the Missouri Medicaid program, as defined above. The second pool shall be distributed annually as a one-time payment, made in addition to per-diem payments, to all Medicaid enrolled hospitals based on their pro-rata share of Medicaid days.

AUTHORITY: sections 208.153 and 208.201, RSMo 2000.* Emergency rule filed April 9, 13 CSR 70-15 2001, effective April 19, 2001, expired Oct. 15, 2001. Original rule filed April 9, 2001, effective Sept. 30, 2001. *Original authority: 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991; and 208.201, RSMo 1987.