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					South Carolina Hospital Association
       HITECH Stimulus
           Calculator

 These worksheets have been forwarded to South
   Carolina hospital CFOs. They provide hospital-
specific estimations of ARRA HITECH for your facility
        based on the latest CMS HCRIS data.
  South Carolina Hospital Association
Federal Register Volume 75, Number 8
Wednesday, January 13,

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 422, and 495,
Medicare and Medicaid Programs; Electronic Health Record Incentive Program


Sec. 495.104 Incentive payments to eligible hospitals, Page 1997.




http://www.gpo.gov/fdsys/pkg/FR-2010-01-13/html/E9-31217.htm
  South Carolina Hospital Association
Sec. 495.104 Incentive payments to eligible hospitals (Page 1997)

(a) General rule. A qualifying hospital (as defined in this subpart)
    shall receive the special incentive payment as determined
    under the formulas described in paragraph (c) of this section
    for the period specified in paragraph (b) of this section.
   –    A “qualifying hospital” is primarily determined by meeting Meaningful Use
        Criteria as defined beginning on page 1849
   –    The Meaningful Use definition is complicated and will be difficult to meet
   –    This definition is being challenged by the American Hospital Association
        and most state associations
   –    This report focuses only on the financial impact of the incentive payments
        once eligibility has been met.
    South Carolina Hospital Association
Sec. 495.104 Incentive payments to eligible hospitals (Page 1997)

     Hospitals paid under the Prospective Payment System

•   Hospitals whose first payment   year is FY 2011 may receive such payments for
    FYs 2011 through 2014
•   Hospitals whose first payment   year is FY 2012 may receive such payments for
    FYs 2012 through 2015
•   Hospitals whose first payment   year is FY 2013 may receive such payments for
    FYs 2013 through 2016
•   Hospitals whose first payment   year is FY 2014 may receive such payments for
    FY 2014 through 2016
•   Hospitals whose first payment   year is FY 2015 may receive such payments for
    FY 2015 through 2017.
    South Carolina Hospital Association
Sec. 495.104 Incentive payments to eligible hospitals (Page 1997)

PPS Hospitals will receive a Medicare percentage and a Medicaid
percentage of an initial amount equal to one of the following:
•   For each hospital with 1,149 discharges or fewer during the fiscal year prior to
    the payment year, $2,000,000.
•   For each hospital with at least 1,150 discharges during the payment year will
    receive the base incentive amount of $2,000,000 plus an additional $200 for
    every discharge between 1149 and 23,000 (21,851 discharges)
  South Carolina Hospital Association
PPS Examples:

1) For a hospital with 1,000 discharges the initial amount is only the base amount
   of $2,000,000

2) For a hospital with 10,000 discharges the initial amount is calculated as follows:

                  $2,000,000 + ((10,000 – 1149) * $200)) = $3,770,200


3) For a hospital with 23,000 discharges the initial amount is calculated as follows:

                  $2,000,000 + ((23,000 – 1149) * $200)) = $6,370,200


4) For a hospital with 25,000 (greater than 23,000) discharges the initial amount is
   calculated as follows:
                   $2,000,000 + ((23,000 – 1149) * $200)) = $6,370,200
 South Carolina Hospital Association
                            The Report

Your hospital’s Chief Financial Officer has received an estimation
  of you hospital’s potential receipts based on historical CMS data




 These PowerPoints are samples for point reference only. Follow
                  along on your actual copies.
                          PPS Providers
The report for PPS hospitals includes 2 pages:
•Page 1, Medicare estimations
•Page 2, Medicaid and Consolidated estimations




                                                   Medicaid
               Medicare




                                                 Combined total
                                          Medicare



    Total Available Funds


 Hospitals do not automatically receive the
entire base incentive payment. This section
calculates the total base. Actual distributions
   are based on a Medicare and Medicaid
    Percentage of the overall facility total.
                                         Medicare




Your hospital-specific data was obtained from the
latest HCRIS data available from CMS. The Cost
         Report period is noted above.
                                               Medicare




All variable historical data fields are highlighted and
 can be updated to allow you to enter more recent
Cost Report data or to allow you enter estimations
            in order to review their impact.
                                                                        Medicare




  The initial amount consists of a flat $2,000,000 for every facility.

An additional $200.00 is also available for every discharge between
  1,150 and 23,000 or a maximum amount of 21,851 discharges

In this example:
Qualified Discharges:23,000 – 1,149 = 21,851
Per Discharge Rate: 21,851 x $200 = $4,370,000
              The two amounts combined equal the total initial amount
                       $2,000,000 + $4,370,000=$6,370,000

    Only a portion of this amount is available to hospitals; a
       Medicare percentage and a Medicaid percentage.
          The Medicare Percentage
Total Medicare and Medicare Advantage Days as
         a percent of total hospital days
   Adjusted by a Medicare charity care ratio.

  As charity increases, the Medicare share also
                    increases.




 Note: This is a variable field which will allow you
  to input your hospital’s charity dollars to adjust
                  this estimation.
             The Medicare Percentage


Year 1
pays 100%
of the
Medicare
maximum
incentive
payment

Years 2-4
pay a
declining
percentage
of the
Medicare
maximum
incentive
payment
          The Medicaid Percentage




  The annual distribution has not yet been
defined for the Medicaid portion, however the
   declining percentages apply to the total
 allowable amount. Therefore, the Medicaid
 percentage is applied to the total available
            over the 4 year period.
          The Medicaid Percentage

 The Medicaid percentage is the hospitals
  traditional Medicaid days plus Medicaid
 managed care days as a percent of total
               hospital days.




Adjusted by the same charity care ratio used
        in the Medicare percentage.
               The Medicaid Percentage



The 4 year
total simply
applies the
Medicaid
percentage
to the total
allowable
amount.
         The Medicaid Percentage




 Based on SCDHHS’ current intentions, this
box distributes Medicaid funds on the same 4
year allocations as Medicare and produces a
     4 year total Medicare and Medicaid
               reimbursement.
    South Carolina Hospital Association
Sec. 495.106 Incentive payments to CAHs (Page 1997)

                         Critical Access Hospitals

•   CAHs are subject to the same eligiblity requirements as PPS hospitals
    (meaningful use criteria)
•   A qualifying CAH receives an incentive payment amount equal to its reasonable
    costs incurred for the purchase of certified EHR technology times the Medicare
    share percentage plus an additional 20 percentage points, not to exceed 100%
    of costs.

                    Total EHR Costs X (Medicare Share + 20% )

•   There is no additional payment component to CAHs for a Medicaid share
  Critical Access Hospitals




    The Critical Access Hospitals report
     consist of a Medicare Form Only
 As CAH payments are actual cost-based, no data is available for
estimating these cost, This form completes the data fields available
  from HCRIS data and allows the user to input cost estimations.
            The Medicare Percentage           Medicare
Total Medicare and Medicare Advantage Days as
         a percent of total hospital days
    Adjusted by a Medicare charity care ratio.




 An additional 20 percentage points (not to exceed 100%)
               Medicare



Each years
actual costs

times the
Medicare
Percentage

equals

each years
stimulus
payment
South Carolina Hospital Association
       HITECH Stimulus
           Calculator

   Contact:
   Barney Osborne, VP of Finance and Reimbursement
   South Carolina Hospital Association
   803.744.3544
   bosborne@scha.org

				
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