Hawaii Did Not Comply With Some Provisions of the Quest Expanded Medicaid Demonstration Project When Determining Eligibility for Federal Reimbursement of Uncompensated Care Costs.

摘要

Payments to governmentally operated hospitals to cover their uncompensated care costs are funded with certified public expenditures (CPEs). The State agency is allowed to claim for Federal reimbursement the CPEs for uncompensated care costs. The demonstration's special terms and conditions state that uncompensated care costs included as CPEs must not include inpatient Medicaid fee-for-service shortfalls, the cost of providing nonemergency care to certain aliens, and the cost of providing drugs to individuals eligible for Medicare Part D. The State agency's process to determine the CPEs for claiming Federal reimbursement for the hospitals' uncompensated care costs has three phases: The interim quarterly expenditure payment for each hospital is the basis of the State agency's initial claim for drawing down Federal funds, which is based on the cost-to-charge ratios calculated from the hospital's prior-period Medicare cost report. The annual reconciliation payment for each hospital is calculated by reconciling the interim quarterly expenditure payments with its filed Medicare cost report. The annual reconciliation should be completed within 12 months after the filing of the Medicare cost report. Special terms and conditions of the QUEST Expanded Medicaid demonstration project when determining whether governmentally operated hospitals' uncompensated care costs The final reconciliation payment for each hospital is reconciled with the finalized Medicare cost report for the respective cost-reporting period. The final reconciliation is For State fiscal years 2011 and 2012, Hawaii did not comply with some provisions of the were eligible for Federal reimbursement.