LEGAL NOTICE

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Notice of Intent to Clarify Medicaid Utilization Calculation to Match Cost Report Practice and the Days Included for Newborns Not Enrolled in Medicaid During the Fiscal Year

Notice is hereby given that the Department of Medical Assistance Services (DMAS) intends to clarify the definition of Medicaid Utilization to better articulate the actual practice of calculating Medicaid utilization from the facility cost reports. This notice is intended to satisfy the requirements of 42 C.F.R. § 447.205 and of § 1902(a)(13) of the Social Security Act, 42 U.S.C. § 1396a(a)(13).  The change contained in this public notice is in response to Item 326 PPP of the 2005 Appropriations Act language.   

Medicaid Utilization is primarily used to determine whether or not a facility is eligible for Disproportionate Share Hospital (DSH) payment.  The calculation is generally Medicaid inpatient days divided by total inpatient days at any given facility.  However, there has been a lack of clarity in regulation regarding what constitutes a “Medicaid inpatient day” for this calculation.  Cost report instructions, however, have been clear and consistent in this definition.  This regulatory change will better articulate the definition in regulation.

This regulatory action also states that DMAS does not include days for newborns not enrolled in Medicaid during the fiscal year even though the mother was Medicaid eligible during the birth

A copy of this notice is available for public review from Scott Crawford, Director, Provider Reimbursement Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, and this notice is available for public review on the Regulatory Town Hall (www.townhall.com).  Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Mr. Crawford and such comments are available for review at the same address.