Review of Select Medicare Conditions of Participation and Costs Claimed at Hillsboro Area Hospital from April 1, 2004 Through June 30, 2006

摘要

Section 4201 of the Balanced Budget Act of 1997, P.L. No. 105-33, Social Security Act, S 1820, 42 U.S.C. S 1395i-4, authorized States to establish Medicare Rural Hospital Flexibility Programs and to designate certain facilities as Critical Access Hospitals (CAH). CAHs must meet certain Medicare Conditions of Participation (CoP) (42 CFR pt. 485, subpart F) and guidelines established by the Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program. Section 405(e) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), P.L. No. 108-173, Social Security Act, S 1820(c)(2)(B)(iii), 42 U.S.C. S 1395i-4(c)(2)(B)(iii), allowed CAHs to have up to 25 inpatient beds that could be used for acute care or swing-bed services, with CMS approval. Section 405(a) of the MMA, Social Security Act S 1814(l), 1834(g)(1) and 1883(a)(3), 42 U.S.C. S 1395f(l), 1395m(g)(1) and 1395tt(a)(3), allowed CAHs to receive Medicare reimbursement totaling 101 percent of allowable, allocable, and reasonable costs for payments for services furnished during cost reporting periods beginning on or after January 1, 2004. Hillsboro Area Hospital, Inc. (the hospital), located in Hillsboro, Illinois, is a not-for-profit corporation owned by Hillsboro Area Health System. On April 1, 2004, the State of Illinois designated the hospital a CAH providing inpatient and outpatient services. The hospital received Medicare reimbursement totaling $9.1 million for costs reported on its 2004, 2005, and 2006 Medicare cost reports. Our objectives were to determine whether the hospital complied with select Medicare CoP and reported costs that were allowable, allocable, and reasonable on its 2004, 2005, and 2006 Medicare cost reports.