208.471. Medicaid reimbursement payments to hospitals--FRA assessments--enhanced graduate medical education payments--alternative reimbursement payments to hospital for Medicaid provider agreements or

MISSOURI STATUTES AND CODES

208.471. Medicaid reimbursement payments to hospitals--FRA assessments--enhanced graduate medical education payments--alternative reimbursement payments to hospital for Medicaid provider agreements or

Medicaid reimbursement payments to hospitals--FRAassessments--enhanced graduate medical educationpayments--alternative reimbursement payments to hospital forMedicaid provider agreements or reimbursement for outpatientservices, certain limits not to apply to outpatient services.

208.471. 1. The department of social services shall make payments tothose hospitals which have a Medicaid provider agreement with thedepartment. Prior to June 30, 2002, the payment shall be in an annual,aggregate statewide amount which is at least the same as that paid infiscal year 1991-1992 pursuant to rules in effect on August 30, 1991, underthe federally approved state plan amendments.

2. Beginning July 1, 2002, sections 208.453 to 208.480 shall expireone hundred eighty days after the end of any state fiscal year in which theaggregate federal reimbursement allowance (FRA) assessment on hospitals ismore than eighty-five percent of the sum of aggregate direct Medicaidpayments, uninsured add-on payments and enhanced graduate medical educationpayments, unless during such one hundred eighty-day period, such paymentsor assessments are adjusted prospectively by the director of the departmentof social services to comply with the eighty-five percent test imposed bythis subsection. Enhanced graduate medical education payments shall not beincluded in the calculation required by this subsection if the generalassembly appropriates the state's share of such payments from a sourceother than the federal reimbursement allowance. For purposes of thissection, direct Medicaid payments, uninsured add-on payments and enhancedgraduate medical education payments shall:

(1) Include direct Medicaid payments, uninsured add-on payments andenhanced graduate medical education payments as defined in stateregulations as of July 1, 2000;

(2) Include payments that substantially replace or supplant thepayments described in subdivision (1) of this subsection;

(3) Include new payments that supplement the payments described insubdivision (1) of this subsection; and

(4) Exclude payments and assessments of acute care hospitals with anunsponsored care ratio of at least sixty-five percent that are licensed tooperate less than fifty inpatient beds in which the state's share of suchpayments are made by certification.

3. The division of medical services may provide an alternativereimbursement for outpatient services. Other provisions of law to thecontrary notwithstanding, the payment limits imposed by subdivision (2) ofsubsection 1 of section 208.152 shall not apply to such alternativereimbursement for outpatient services. Such alternative reimbursement mayinclude enhanced payments or grants to hospital-sponsored clinics servinglow income uninsured patients.