2016 New Hampshire Revised Statutes
Title XII - PUBLIC SAFETY AND WELFARE
Chapter 167 - PUBLIC ASSISTANCE TO BLIND, AGED, OR DISABLED PERSONS, AND TO DEPENDENT CHILDREN
Section 167:64 - Uncompensated Care and Medicaid Fund.

    167:64 Uncompensated Care and Medicaid Fund. –
    I. There is hereby established in the state treasury an uncompensated care and Medicaid fund which shall consist of the moneys collected pursuant to RSA 84-A. Investment earnings of the fund shall be credited to the fund. Moneys paid into the fund shall be exempt from any state budget reductions, and the commissioner is authorized to expend these funds, together with matching federal funds, as follows:
       (a)(1) The commissioner shall provide reimbursement for uncompensated care costs in accordance with the approved schedule of payments through either Medicaid rate adjustments or disproportionate share hospital payment adjustments, or a combination thereof, provided however that no hospital shall receive any such reimbursement for uncompensated care costs unless it is a qualified hospital as defined in subparagraph (b)(1). Funds available under this section shall also be used to make provider payments and to support Medicaid services and programs administered by the department in amounts directed by the budget in each year of the biennium.
          (2) Expenditure of revenues deposited to the uncompensated care and Medicaid fund shall be made for the following purposes in the following order of priority in fiscal year 2015:
             (A) To support medical provider payments as budgeted in each year of the biennium;
             (B) To make disproportionate share hospital payments to support up to 75 percent of the uncompensated care costs of New Hampshire's hospitals with critical access designation consistent with the requirements of 42 U.S.C. section 1396r-4(g) and any relevant federal regulations promulgated thereunder as budgeted in each year of the biennium based on available funding, to be shared among such hospitals in proportion to the amount of uncompensated care provided;
             (C) To make disproportionate share hospital payments to support the uncompensated care costs of New Hampshire's general hospitals without critical access designation shared among such hospitals consistent with the requirements of 42 U.S.C. section 1396r-4(g) and any relevant federal regulations promulgated thereunder in proportion to the amount of uncompensated care provided with funds available from net Medicaid enhancement tax revenue received by the state in fiscal year 2015 in excess of $190,300,000; and
             (D) To make a disproportionate share hospital payment to each hospital that meets the criteria set forth for "deemed disproportionate share hospitals'' as that term is defined under 42 U.S.C. section 1396r-4 up to an amount as budgeted in each year of the biennium based on available funding.
          (3) Subject to subparagraph (a)(3)(D), expenditure of revenues deposited to the uncompensated care and Medicaid fund shall be made for the following purposes in the following order of priority in fiscal years 2016, 2017, 2018, and 2019, and in addition in fiscal years 2016, 2017, 2018, and 2019, if New Hampshire hospitals' total aggregate uncompensated care costs as reported to the department in any such fiscal year is less than $350,000,000, the state shall pay New Hampshire's hospitals not less than $175,000,000 in disproportionate share hospital payments, shared among such hospitals in proportion to the amount of uncompensated care provided; provided that New Hampshire hospitals with a critical access hospital designation shall continue to receive reimbursements of no less than 75 percent of each hospital's uncompensated care costs and no hospital shall be paid disproportionate share hospital payments of more than 100 percent of uncompensated care costs:
             (A) To make disproportionate share hospital payments to New Hampshire hospitals with and without critical access designation in the following order of priority, provided that, in fiscal years 2016 and 2017, the New Hampshire hospitals shall not be paid more than a cap of $224,000,000 in disproportionate share hospital payments and in fiscal years 2018 and 2019 the New Hampshire hospitals shall not be paid more than a cap of $241,900,000 in disproportionate share hospital payments:
                (i) To support 75 percent of the uncompensated care costs of New Hampshire's hospitals with critical access designation consistent with the requirements of 42 U.S.C. section 1396r-4(g) and any relevant federal regulations promulgated thereunder to be shared among such hospitals in proportion to the amount of uncompensated care provided;
                (ii) To make disproportionate share hospital payments to support 50 percent of the uncompensated care costs of New Hampshire's hospitals without critical access hospital designation in fiscal year 2016 and 2017 and 55 percent of uncompensated care costs of New Hampshire's hospitals without critical access hospital designation in fiscal year 2018 and fiscal year 2019 and in fiscal years thereafter consistent with the requirements of 42 U.S.C. section 1396r-4(g) and any relevant federal regulations promulgated thereunder in proportion to the amount of uncompensated care provided and up to the remaining amount of the applicable cap set forth in subparagraph (a)(3)(A), but not less than the amount guaranteed in disproportionate share hospital payments as set forth in subparagraph (a)(3); and
             (B) To make a disproportionate share hospital payment to each hospital that meets the criteria set forth for "deemed disproportionate share hospitals'' as that term is defined under 42 U.S.C. section 1396r-4 up to an amount as budgeted in each year of the biennium.
             (C) Any remaining funds produced from the Medicaid enhancement tax shall be used to support provider payments and to support Medicaid services and programs administered by the department.
             (D) Notwithstanding any provision to the contrary, in each of fiscal years 2016, 2017, 2018, and 2019, the amount of uncompensated care reimbursed to non-critical access hospitals shall be reduced in both state contribution and federal match by any shortfall in net Medicaid enhancement tax revenues received below the following thresholds: fiscal year 2016--$220.5 million; fiscal year 2017--$228.1 million; fiscal year 2018--$235.9 million; and fiscal year 2019--$243.4 million. However, to the extent the aggregate uncompensated care for all hospitals falls below $375 million and the Medicaid enhancement tax rate is further reduced as set forth in RSA 84-A:2, V, then the threshold for fiscal year 2018 shall be $229.4 million and for fiscal year 2019 shall be $235.7 million. Further, the caps in subparagraph (a)(3)(A) and the reimbursements and caps in subparagraph (a)(3)(A)(ii) shall be reduced by 85 percent of the difference between total Medicaid enhancement tax revenue calculated at 5.5 percent of net patient services revenue and Medicaid enhancement tax revenue at the current tax rate for the applicable fiscal year.
       (b)(1) The commissioner is hereby authorized and directed to develop and implement a schedule of payments for reimbursement of the uncompensated care costs consistent with the level of funding made available for such payments in each year of any biennium, incurred by those hospitals that are qualified as follows:
             (A) The hospital is a "deemed disproportionate share hospital'' as defined by criteria set forth under 42 U.S.C. section 1396r-4 and is not otherwise receiving a disproportionate share hospital payment; or
             (B) The hospital:
                (i) Meets the minimum criteria for disproportionate share eligibility under relevant federal statutory changes at 42 U.S.C. 1396r-4(d);
                (ii) Is not a special hospital for rehabilitation; and
                (iii) Participates in the provider network of the state Medicaid care management program.
          (2) The reimbursement of uncompensated care costs paid in state fiscal year 2015 and thereafter shall be in accordance with the schedule of payments to hospitals consistent with this section and shall be structured in a manner that is consistent with all federal laws and regulations governing (i) Title XIX disproportionate share hospital payment adjustments and other rate payments, (ii) conditions for receiving federal financial participation, and (iii) permissible sources of state financial participation as provided for under 42 C.F.R. part 433 and all other applicable federal regulations. Disproportionate share hospital payments shall be made under this paragraph by May 31 in any fiscal year.
       (c) For purposes of this section, uncompensated care costs shall include: any charity care cost, and any portion of Medicaid-covered patient care costs unreimbursed by Medicaid payments, that the commissioner determines would meet the criteria under 42 U.S.C. section 1396r-4(g) governing hospital-specific limits on disproportionate share hospital payments under Title XIX of the Social Security Act and the provisions of all federal regulations promulgated thereunder.
       (d) One percent of the funds made available for uncompensated care payments shall be placed in a separate class line reserved for the expenses of the department in administering this subdivision.
    II. Moneys in the uncompensated care and Medicaid fund shall be continually appropriated to the department for the purposes of this subdivision.
    III. The department shall secure all necessary waivers pursuant to 42 C.F.R. section 433.68 and approvals of state plan amendments from the Centers for Medicare and Medicaid Services (CMS).
    IV. Payment of disproportionate share hospital payments under this section is contingent upon New Hampshire receiving a sufficient federal Medicaid disproportionate share hospital allotment from CMS.

Source. 1991, 299:5; 390:6, 7. 1993, 4:10-12, 16, IV; 358:8. 1994, 122:8. 2009, 144:212. 2011, 224:36. 2013, 144:47, eff. July 1, 2013. 2014, 158:13, eff. June 30, 2014.