Common use of Uncompensated Care Cost Limit Clause in Contracts

Uncompensated Care Cost Limit. The aggregate amount of SNCP payments to the providers identified in Attachment J will not exceed the SNCP amount of $332 million per DY. The annual SNCP payment distributed to each individual provider will not exceed its uncompensated care costs for providing section 1905(a) medical services to Medicaid eligible and uninsured individuals for the period. The State must submit to CMS for approval and incorporation into Attachment I a claiming protocol for each provider type to provide for the computation of a provider's uncompensated care costs. No FFP is available for SNCP payments until the associated claiming protocol is approved by CMS. Such protocols must take into consideration: i. The cost reporting tool (i.e., the CMS-2552 cost report for hospital providers, and other cost reports for non-hospital providers as approved by CMS) to be used to determine a provider's allowable patient care costs, consistent with Medicare cost principles and OMB Circular A-87, for a specific service period. ii. A methodology to apportion allowable patient care costs to Section 1905(a) services furnished to Medicaid eligible and uninsured individuals. iii. An offset of all payments received for the services furnished to Medicaid eligible and uninsured individuals, including all Medicaid payments, third party payments, and payments by or on behalf of the patients, to arrive at the provider's uncompensated care cost. iv. A carve-out of costs associated with non-emergency services provided to non-qualified aliens, which is a prohibited use of SNCP funds. v. A payment methodology to allow the State to distribute SNCP payments to providers based on projected uncompensated care costs. vi. Reconciliations of payments to the provider's uncompensated care cost limits as computed based on the provider's as-filed and finalized cost reports for the actual service period. The uncompensated care cost limit is computed and SNCP payments are made on a DY basis. To the extent that a provider's cost reporting period does not coincide with the DY, the cost protocol will provide for an allocation of uncompensated care costs to the DY. Any SNCP payments made in excess of the individual provider's uncompensated care cost limit for a demonstration period will be recouped from the provider, and the Federal share of the overpayment will be returned to CMS.

Uncompensated Care Cost Limit. The aggregate amount of SNCP payments made to the Safety Net Hospital Systems and their affiliated providers identified in pursuant to sections A through C of Attachment J will not exceed the SNCP amount of $332 million per DYDY (the “Safety Net Hospital System Limit”). The aggregate amount of SNCP payments made to the City of Phoenix High Uncompensated Care Hospitals and their affiliated providers pursuant to section D of Attachment J will not exceed the amount of $385 million per DY (the “Phoenix Hospital Limit”). The annual SNCP payment distributed to each individual provider will not exceed its uncompensated care costs for providing section 1905(a) medical services to Medicaid eligible and uninsured individuals for the period. The State must submit to CMS for approval and incorporation into Attachment I a claiming protocol for each provider type to provide for the computation of a provider's uncompensated care costs. No FFP is available for SNCP payments until the associated claiming protocol is approved by CMS. Such protocols must take into consideration: i. The cost reporting tool (i.e., the CMS-2552 cost report for hospital providers, and other cost reports for non-hospital providers as approved by CMS) to be used to determine a provider's allowable patient care costs, consistent with Medicare cost principles and OMB Circular A-87, for a specific service period. ii. A methodology to apportion allowable patient care costs to Section 1905(a) services furnished to Medicaid eligible and uninsured individuals. iii. An offset of all payments received for the services furnished to Medicaid eligible and uninsured individuals, including all Medicaid payments, third party payments, and payments by or on behalf of the patients, to arrive at the provider's uncompensated care cost. iv. A carve-out of costs associated with non-emergency services provided to non-qualified aliens, which is a prohibited use of SNCP funds. v. A payment methodology to allow the State to distribute SNCP payments to providers based on projected uncompensated care costs. vi. Reconciliations of payments to the provider's uncompensated care cost limits as computed based on the provider's as-filed and finalized cost reports for the actual service period. The uncompensated care cost limit is computed and SNCP payments are made on a DY basis. To the extent that a provider's cost reporting period does not coincide with the DY, the cost protocol will provide for an allocation of uncompensated care costs to the DY. Any SNCP payments made in excess of the individual provider's uncompensated care cost limit for a demonstration period will be recouped from the provider, and the Federal share of the overpayment will be returned to CMS.