Overview
Title XIX of the Social Security Act (Act) authorizes grants to states for Medicaid programs. Section 1902(a)(13)(A)(iv) of the Act requires that states make Medicaid payment adjustments for hospitals that serve a disproportionate share of low-income patients with special needs.
On December 19, 2008, the Centers for Medicare & Medicaid Services (CMS) published a final rule in the Federal Register (73 Fed. Reg. 77904) implementing the reporting and auditing requirements for state Disproportionate Share Hospital (DSH) payments under state Medicaid programs, effective January 19, 2009. The final rule:
- Sets forth the data elements necessary to comply with the DSH auditing and reporting requirements of Section 1923(j) of the Act. These requirements were added by Section 1001(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
- Requires states to verify their methodology for computing the hospital-specific DSH limit and the DSH payments made to hospitals.
- Adds Sec. 455.204(a) to reflect Section 1923(j) of the Act’s requirement that each state must submit annually an independent certified audit of its DSH program as a condition for receiving federal payments under Sections 1903(a)(1) and 1923 of the Act.
States have been required to obtain an independent certified audit, beginning with an audit of the State fiscal year (FY) 2005 DSH program and thereafter. Beginning with Medicaid State Plan years 2011 and thereafter, the Oregon Health Authority (OHA) is required to recover DSH payments made to a hospital in excess of its audited DSH limit.
DSH Surveys
Myers and Stauffer LC conducts surveys for OHA to ensure DSH payments comply with federal requirements. The most recent survey documents are listed below.