# 10%Medicaid

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11/24/2011
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```							HOSPITAL NAME:

HOSPITAL CONFIRMATION THAT 10% OF ITS INPATIENT DAYS ARE MEDICAID

You will need to confirm (Attest) that you meet the percentage of Medicaid encounters
needed to get a Medicaid incentive payment.
From        To
Choose any 90 consecutive days from October 1, 2010 through
September 30, 2011. Note: the 90 day period does not have to begin
ng on the first of a month.
Total number of discharges that occurred during that 90 days

Total number of inpatient days that occurred during the 90 days.
Note: If you chose January 1 through March 30, the total in-patient
days would include all inpatient days for that "discharge." If a patient
was admitted on December 15th and discharged on January 4th, you
would count all of the inpatient days associated with that discharge--in
this example, 20.

Total number of Medicaid discharges that occurred during that 90
days. Note: A Medicaid discharge includes inpatient days where
Medicaid is the primary, secondary, or payer of last resort.

Total number of inpatient days associated with each discharge.

Percentage of Medicaid inpatient days (called encounters)*
Source of data used for calculation

*If the percentage of Medicaid in-patient days (encounters) is at least 10% the
hospital meets the percentage requirement for Medicaid incentive payments.
Note: If the percentage is less than 10% contact MaineCare for an alternative
method of calculation.
MAINE MEDICAID HIT HOSPITAL PAYMENT CALCULATION

Step 1:    Compute the average annual growth rate over 3 years using the previous Medicare cost reports
(Enter data only in the cells highlighted in yellow.)
Source:    Worksheet S-3, Part I, line 12, column 15 - Total Discharges

Hospital
Fiscal Year                   Next fiscal year Increase         % increase
Fiscal Year 2007 -->             0          2008 -->                 0                0 #DIV/0!

Fiscal year 2008 -->                0       2009 -->               0                  0   #DIV/0!

Fiscal year 2009 -->                0       2010 -->               0                  0   #DIV/0!
Total % Increase                                  #DIV/0!
Equates to:
Divide by 3 years for       Average Annual Growth Rate                        #DIV/0!        #DIV/0!

Step 2:    Applying average growth rates, compute total discharges related amount

(discharges over 1,149 but less than 23,000 are used to calculate a discharge amount per year)

Source:    Worksheet S-3, Part I, line 12, column 15                              2010 Discharges                                 0
Discharges to use for next
year based on growth rate
Year 1 (allowed dischg 2010 discharges - 1149) X \$200                                                   \$0               #DIV/0!

Year 2 (allowed dischgs 2010 compounded avg annual growth - 1149) X \$200                      #DIV/0!                    #DIV/0!

Year 3 (allowed dischgs 2010 compounded avg annual growth - 1149) X \$200                      #DIV/0!                    #DIV/0!

Year 4 (allowed dischgs 2010 compounded avg annual growth - 1149) X \$200                      #DIV/0!

Total 4 year discharge related amount                          #DIV/0!
MAINE MEDICAID HIT HOSPITAL PAYMENT CALCULATION

Step 3:    Compute 4 year amount by adding base to discharges                       Year 1              Year 2      Year 3        Year 4

Year 1- 4 base amount of \$2,000,000                    \$2,000,000         \$2,000,000 \$2,000,000       \$2,000,000

Year 1-4 discharge related amount (step 2)                       \$0       #DIV/0!         #DIV/0!      #DIV/0!

Aggregate EHR amount for 4 years                       \$2,000,000         #DIV/0!         #DIV/0!      #DIV/0!

Step 4:    Apply a Transition Factor to Step 3 Amounts                              100%                   75%        50%           25%
\$2,000,000         #DIV/0!         #DIV/0!      #DIV/0!

Step 5:    Add the 4 year amounts from Step 4                                                                                 #DIV/0!

Step 6:     Compute the Number of Hospital Days Allowed for the E H R Calculation
(Enter data only in the cells highlighted in yellow.)
Source:     Most recent years data (Hos. FY 2010)
Formula: (Medicaid inpatient-bed-days + estimated Medicaid HMO inpatient -bed-day)/
(Medicaid inpatient-bed-days X (est. total charges - est. charity care charges)/est. total charges

Source:    Worksheet S-3, Part I, Line 12, Col. 5 (minus nursery days)                       total Medicaid Days                         0
Source:    Worksheet S-3, Part I, Line 2, Col. 5 (minus nursery days)                        total Medicaid HMO Days                     0

Source:    Worksheet C, part I, Line 101, col. 8                         Gross total hospital charges                                   \$0
Source:    Worksheet S-10, Line 30                                       Uncompensated care charges                                     \$0
Net total hospital charges - charity charges.                             \$0
Divide Net by gross hospital charges to get non-charity %              #DIV/0!
Source:    Worksheet S-3, Part I, Col 6 line 12 (minus nurs. Days)       Total Hospital days                                             0

Multiply total hos. days by non-charity % to get allowed days                  #DIV/0!
MAINE MEDICAID HIT HOSPITAL PAYMENT CALCULATION

Step 7:        Compute Medicaid aggregated EHR incentive amount

Aggregate E H R Amount for 4 years                                            #DIV/0!
(Total Medicaid and HMO Medicaid days) divided by non-charity hospital days   #DIV/0!
Multiply the E H R aggregate amount by Medicaid percentage

Medicaid Aggregate E H R Hospital Incentive Amount      #DIV/0!

Step 8:        Compute Medicaid annual E H R incentive amount

Year one payment = 50%                                             #DIV/0!
Year two payment = 40%                                             #DIV/0!
Year three payment = 10%                                           #DIV/0!

10/10/2011

```
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