PURPOSE: This rule establishes procedures for reporting financial data by hospitals to the Department of Health.

1. (1) Hospitals shall report the financial data listed in Exhibit D of this rule, included herein, for the previous fiscal year to the Department of Health by April 15 of each year starting in 1993. If any data element has been submitted previously to the Division of Medical Services of the Department of Social Services, the hospital does not have to report that data to the Department of Health. The Department of Health shall notify each hospital what data elements are not available from the Division of Medical Services.
2. (2) Hospitals may provide the financial data directly or through an association to the Department of Health from the financial section of the annual licensing survey.
3. (3) The Department of Health shall develop and publish reports pertaining to individual hospitals. The reports and the data they contain shall be public information and may be released on magnetic media. The Department of Health shall make the reports and data available for a reasonable charge based upon incurred costs.
4. (4) The Department of Health may develop reports and release data upon request which do not directly or indirectly identify individual hospitals. The reports and data shall be public information and may be released on magnetic media. The Department of Health shall make the reports and data available for a reasonable charge based upon incurred costs.
5. (5) Any provider which determines it temporarily will be unable to comply with any of the provisions of this rule or with the provisions of a previously-submitted plan of correction can provide the Department of Health with written notification of the expected deficiencies and a written plan of correction. The notification and plan of correction shall include the section number and text of the rule in question, specific reasons why the provider cannot comply with the rule, an explanation of any extenuating factors which may be relevant, the means the provider will employ for correcting the expected deficiency and the date by which each corrective measure will be completed.
6. (6) Any provider which is not in compliance with this rule shall be notified in writing by the Department of Health. The notification shall specify the deficiency and the action which must be taken to be in compliance. The chief executive officer or designee shall have ten (10) working days following receipt of the written notification of noncompliance to provide the Department of Health with a written plan for correcting the deficiency. The plan of correction shall specify the means the provider will employ for correcting the cited deficiency and the date that each corrective measure will be completed.
7. (7) Upon receipt of a required plan of correction, the Department of Health shall review the plan to determine the appropriateness of the corrective action. If the plan is acceptable, the Department of Health shall notify the chief executive officer or designee in writing and indicate that implementation of the plan should proceed. If the plan is not acceptable, the Department of Health shall notify the chief executive officer or designee in writing and indicate the reasons why the plan was not accepted. A revised, acceptable plan of correction shall be provided to the Department of Health within ten (10) working days.
8. (8) Failure of the provider to submit an acceptable plan of correction within the required time shall be considered continued and substantial noncompliance with this rule unless determined otherwise by the director of the Department of Health.
9. (9) Failure of any provider to follow its accepted plan of correction shall be considered continued and substantial noncompliance with this rule unless determined otherwise by the director of the Department of Health.
10. (10) Any provider in continued and substantial noncompliance with this rule shall be notified by registered mail and reported by the Department of Health to its Bureau of Hospital Licensing and Certification, Bureau of Narcotics and Dangerous Drugs, Bureau of Emergency Medical Services, Bureau of Home Health Licensing and Certification, Bureau of Radiological Health, State Public Health Laboratory, Bureau of Special Health Care Needs, the Division of Medical Services of the Department of Social Services, the Division of Vocational Rehabilitation of the Department of Elementary and Secondary Education and to other state agencies that administer a program with provider participation. The Department of Health shall notify the agencies that the provider is no longer eligible for participation in a state program.
11. (11) Any provider that has been declared to be ineligible for participation in a state program shall be eligible for reinstatement by correcting the deficiencies and making written application for reinstatement to the Department of Health. Any provider meeting the requirements for reinstatement shall be notified by registered mail. The Department of Health shall notify state agencies that administer a program with provider participation that the provider’s eligibility for participation in a state program has been reinstated. 1a. Cash and cash equivalents 1b. Net patient accounts receivable 1c. Other current assets 1d. Total current assets 2a. Fixed assets at cost 2b. Less: accumulated depreciation 2c. Fixed assets (net)
12. 3. Other assets
13. 4. Total assets
14. 5. Current liabilities
15. 6. Long-term debt
16. 7. Other long-term liabilities
17. 8. Fund balance
18. 9. Total liabilities and fund balance

1a. Inpatient revenue 1b. Outpatient revenue 1c. Total gross patient revenue 2a. Charity care 2b. Other allowances and deductions 2c. Total deductions and allowances 3. Net patient revenue 4. Other revenue 5. Total revenue 6a. Payroll expenses 6b. Employee benefits 6c. Depreciation expense 6d. Bad debt expense 6e. All other operating expenses 6f. Total operating expenses 7. Net income from operations 8a. Investment income 8b. Contributions 8c. Tax support and other subsidies 8d. Miscellaneous gains and losses 8e. Nonoperating gains and losses 9. Net income before extraordinary and other nonrecurring items 10. Extraordinary gains and losses 11. Net income

SUPPLEMENTAL ITEMS***

1. 1. If depreciation is funded, balance at end of reporting period 2a. Medicare gross patient revenue 2b. Medicaid gross patient revenue 2c. Other government patient revenue 2d. Nongovernment patient revenue EXHIBIT D

Financial Data Elements

BALANCE SHEET* ________________________________ ________________________________ ________________________________

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INCOME STATEMENT**

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________________________________ Definitions for Exhibit D

Balance Sheet*

1a. Cash and cash equivalents means money on hand, and includes money in checking accounts, time deposits, temporary cash investments and uninvested funds held by investment custodians.

1b. Net patient accounts receivable means accounts receivable, net of estimated uncollectibles.

1c. Other current assets means other accounts receivable, notes receivable and may include the current portion of assets whose use is limited, prepaid expenses, inventory and short-term investments.

1d. Total current assets means the sum of lines 1a. through 1c.

2a. Fixed assets at cost means land, land improvements, buildings and improvements, leasehold improvements, equipment (fixed and movable), leased property and equipment, and construction in progress, at cost.

2b. Accumulated depreciation means depreciation and amortization.

2c. Fixed assets (net) means fixed assets at cost (line 2a.) less accumulated depreciation (line 2b.).

1. 3. Other assets means all other assets, and may include deferred financing costs, unamortized bond issue costs, investment in affiliated company, deferred third-party reimbursement and other assets.
2. 4. Total assets means the sum of lines 1d., 2c. and 3.
3. 5. Current liabilities means those which will be discharged with current assets, and may include notes payable to banks; the current portion of long-term debt; accounts payable; advances from and amounts payable to third-party payers for estimated and final reimbursement settlements; refunds to and deposits from patients and others; deferred revenue; accrued salaries and payroll taxes; and other accruals such as pension or profit-sharing contributions, compensated absences, and income and other taxes.
4. 6. Long-term debt means notes payable, mortgages payable, capital leases, bonds payable and loans/contracts payable.
5. 7. Other long-term liabilities means other long-term obligations, and may include estimated malpractice costs, deferred compensation payable, deferred third-party reimbursement and accrued pension/deferred pension liability.
6. 8. Fund balance means the excess of assets over liabilities (net equity). An excess of liabilities over assets is reflected as a deficit.
7. 9. Total liabilities and fund balance means the sum of lines 5.–8. Must agree with total assets, line 4. Income Statement**

1a. Inpatient revenue means full hospital charges for all hospital services to inpatients. 1b. Outpatient revenue means full hospital charges for all hospital services to outpatients. 1c. Total gross patient revenue means the sum of lines 1a. and 1b. Full hospital charges for all hospital patient services before considering any deductions for charity care or contractual allowances.

2b. Other allowances and deductions means revenue deductions incurred in treating patients other than charity patients, including Medicare, Medicaid, other insured and uninsured patients. It includes courtesy discounts given to employees and others. It does not include bad debt expense, which is to be reported as an operating expense (line 6d.).

2c. Total allowance and deductions means the sum of lines 2a. and 2b. 3. Net patient revenue means total gross revenue (line 2.) less total allowances and deductions (line 2c.). 4. Other revenue means revenue from services other than health care provided to patients and residents, and includes sales and services to nonpatients. This revenue arises from the normal day-to-day operations of the health care entity. Other revenues may include: revenue such as gifts, grants, or endowment income restricted by donors to finance charity care; revenue from educational programs; revenue from research and other gifts and grants; revenue from miscellaneous sources, such as rental of facility space, sales of medical and pharmacy supplies, fees charged for transcripts for attorneys, insurance companies and others, proceeds from the sale of cafeteria meals and guest trays, proceeds from the sale of scrap, used X-ray film, and proceeds from sales at gift shops, snack bars, newsstands, parking lots, vending machines and other service facilities operated by the health care entity. 5. Total revenue means the sum of lines 3. and 4.

6a. Payroll expenses means salaries and wages paid to employees of the health care entity. 6b. Employee benefits means Social Security, group insurance, retirement benefits, Workers’ Compensation, unemployment insurance and others.

6c. Depreciation expense means depreciation and amortization of property and equipment recorded for the reporting period. 6d. Bad debt expense means revenue amounts deemed uncollectible primarily because of a patient’s unwillingness to pay as determined after collection efforts based upon sound credit and collection policies. It does not include charity care, which is to be reported on line 2a. 6e. All other operating expenses means expenses for professional fees, interest, supplies, purchased services, utilities, income taxes, operating losses and any other expenses not included in the above categories. 6f. Total operating expenses means the sum of lines 6a.–6e. 7. Income from operations means total revenue (line 5.) less total operating expenses (line 6f.).

8a. Investment income means return on investments of general funds, except that investment income and realized gains and losses on borrowed funds held by a trustee, investment income on malpractice trust funds and investment income that is essential to the ongoing major or central operations are included in other revenue (line 4.).

8b. Contributions means contributions, donations and bequests for general operating purposes from foundations, similar groups or individuals, or any combination of these. 8c. Tax support and other subsidies means tax levies and other subsidies from governmental or community agencies received for general support of the entity. 8d. Miscellaneous gains and losses means all other gains and losses from a provider’s peripheral or incidental transactions, such as gain or loss on sale of health care entity properties; net rentals of facilities used in the operation of the entity; and term endowment funds that are available for general operating purposes upon termination of restrictions.

8e. Nonoperating gains and losses means the sum of lines 8a.–8d. 9. Net income before extraordinary and other nonrecurring items means the sum of net income from operations (line 7.) and nonoperating gains and losses (line 8e.).

1. 10. Extraordinary gains and losses means gains or losses unusual in amount and nonrecurring in nature that do not result from normal operating activities. Events or transactions that occur frequently in the health care environment, such as large, unrestricted gifts, cannot be regarded as extraordinary, regardless of their financial effect, and are to be included in ordinary income.
2. 11. Net income means the sum of lines 9. and 10. Supplemental Items***
3. 1. Funded depreciation means cash resources which have been set aside and accumulated for the purpose of financing the renewal or replacement of plant assets.

2a. Medicare gross patient revenue means full hospital charges for all hospital services provided to Medicare patients.

2b. Medicaid gross patient revenue means full hospital charges for all hospital services provided to Medicaid patients.

2c. Other government patient revenue means full hospital charges for all hospital services provided to other government patients, including CHAMPUS, government retirement and Crippled Children’s Service.

2d. Nongovernment patient revenue means full hospital charges for all hospital services provided to nongovernment patients, including those with private insurance, those belonging to HMOs or PPOs, and those without insurance. AUTHORITY: section 192.667, RSMo 2000.* Emergency rule filed Nov. 4, 1992, effective Nov. 14, 1992, expired March 13, 1993. Emergency rule filed March 4, 1993, effective March 14, 1993, expired July 11, 1993. Original rule filed Nov. 4, 1992, effective June 7, 1993. Emergency amendment filed April 1, 1993, effective April 11, 1993, expired Aug. 8, 1993. Emergency amendment filed Aug. 10, 1993, effective Aug. 20, 1993, expired Nov. 18, 1993. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed April 13, 2001, effective Oct. 30, 2001. *Original authority: 192.667, RSMo 1992, amended 1993, 1995.