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Program D: Uncompensated Care Costs Payments

PROGRAM DESCRIPTION

The mission of the Uncompensated Care Cost Payments Program (formerly known as Disproportionate Share [DSH] payments) is to encourage hospitals and providers to serve uninsured and indigent clients. As a result, the quality and access to care is improved. Prior to 1989, all uncompensated medical costs (100%) for the uninsured were financed by the State General Fund. As a result of the Uncompensated Care Cost Program, these state general funds are now matched with federal funds to cover 100% of cost.

The goal of the Uncompensated Care Costs (UCC) Payments Program is to reduce reliance on the State General Fund to cover Medicaid expenditures.

This program provides payments to the following: LSU Medical Center, LSU Medical Center Health Care Services Division, DHH Psychiatric Hospitals, and Private Hospitals.

Federal law requires that Medicaid UCC payments are made to qualifying hospitals. Under federal law, UCC payments to each UCC hospital may not exceed that individual hospital's uncompensated costs. The state has the flexibility in varying payment methodologies according to type of hospital as long as certain criteria mandated by federal regulations are met.

OBJECTIVES AND PERFORMANCE INDICATORS

Unless otherwise indicated, all objectives are to be accomplished during or by the end of FY 1999-2000. Performance indicators are made up of two parts: name and value. The indicator name describes what is being measured. The indicator value is the numeric value or level achieved within a given measurement period. For budgeting purposes, performance indicator values are shown for the prior fiscal year, the current fiscal year, and alternative funding scenarios (continuation budget level and Executive Budget recommendation level) for the ensuing fiscal year (the fiscal year of the budget document).

 

 

RESOURCE ALLOCATION FOR THE PROGRAM

SOURCE OF FUNDING

This program is funded with General Fund, Fees and Self-generated Revenues, Statutory Dedications, and Federal Funds. The Self-generated Revenues in the existing operating budget derive from prior years overcollections from the LSU Health Care Services Division facilities and the DHH Inpatient Mental facilities. The Statutory Dedication, also only in the existing operating budget, is the Louisiana Medical Assistance Trust Fund which derives its funding source from the collection of provider fees from varying medical providers in the state based on corresponding per bed per day rates. (Per R.S.39:32B.(8), see table below for a listing of expenditures out of each statutory dedicated fund.) Federal Funds represent federal financial participation in the Medicaid program.

ANALYSIS OF RECOMMENDATION

GENERAL FUND

TOTAL

T.O.

DESCRIPTION

 

 

 

 

 

$208,242,760

$768,383,403

0

 

ACT 19 FISCAL YEAR 1998-1999

 

 

 

 

 

 

 

 

 

BA-7 TRANSACTIONS:

$0

$6,779,745

0

 

This BA-7 increased the expenditures of this program to allow for a one-time reimbursement to three specific large rural hospitals which did not qualify for reimbursement under current guidelines.

$0

$0

0

 

This BA-7 properly aligned the means of financing in this program by increasing self-generated revenues by $13,118,095 and statutory dedications by $881,905 and decreasing interagency transfers by $14,000,000. This increase in anticipated statutory dedications is not related to the previous BA-7.

 

 

 

 

 

$208,242,760

$775,163,148

0

 

EXISTING OPERATING BUDGET - November 20, 1998

 

 

 

 

 

$0

($6,779,745)

0

Other Nonrecurring Adjustments - An adjustment to remove the federal funds added by BA-7 for the one-time payment of UCC to three large rural hospitals

($955,662)

($3,219,885)

0

Other Adjustments - An adjustment to balance to the anticipated utilization of Uncompensated Care Costs payments in the budgets of varying public agencies

($192,493)

$0

0

Means of Financing Substitution(s) - Replace general fund with federal funds in response to the change in the Federal Medical Assistance Percentage from 29.63% in FY 1999 to 29.68% in FY 2000 and to need to properly align the revenue base in this program

$14,069,927

$0

0

Means of Financing Substitution(s) - Replace $951,832 in statutory dedications and $13,118,095 in self-generated revenues with general fund to remove all nonrecurring revenue from the means of financing base

 

 

 

 

 

$221,164,532

$765,163,518

0

 

TOTAL RECOMMENDED

 

 

 

 

 

$12,921,772

($9,999,630)

0

 

DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 98.7% of the existing operating budget. It represents 99.6% of the total request ($768,383,403) for this program. The tow substantive changes to this program are the removal of the one time compensation for those three rural hospitals and the balancing of this program's budget to the expenditures budgeted in the various public agencies which are reimbursable under applicable law for medical care given to persons uninsured, unable to pay, and ineligible for Medicaid. The increase in general fund is due to the means of financing substitution removing the $14.1 million of nonrecurring revenue from the base.

PROFESSIONAL SERVICES

This program does not have funding for Professional Services for Fiscal Year 1999-2000.

OTHER CHARGES

$31,014,289

 

Reimbursements to Private, Rural Hospitals for the provision of medical services to patients who are uninsured and ineligible for the State’s Medicaid program

 

 

 

$31,014,289

 

TOTAL OTHER CHARGES

 

 

 

 

 

Interagency Transfers for the reimbursement to following public providers for the provision of medical services to patients who are uninsured and ineligible for the State’s Medicaid program:

$99,837,471

LSUMC – Shreveport

$554,033,583

LSUMC, Health Care Services Division

$79,382,104

Office of Mental Health

$896,071

Villa Feliciana Medical Complex

 

 

 

$734,149,229

 

TOTAL INTERAGENCY TRANSFERS

ACQUISITIONS AND MAJOR REPAIRS

This program does not have funding for Acquisitions and Major Repairs for Fiscal Year 1999-2000.


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