HP0628, LD 831, item 1, An Act To Protect the State from Accumulating Future Hospital Debt

An Act To Protect the State from Accumulating Future Hospital Debt

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 22 MRSA §1714-D is enacted to read:

§ 1714-D. Hospital interim settlements

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A. "As-filed Medicare cost report" means the cost report that a hospital files with a Medicare fiscal intermediary and with MaineCare, using the federal Centers for Medicare and Medicaid Services Medicare cost report form containing all information required by the department.

B. "MaineCare paid claims history" means a summary of all claims billed by a hospital to MaineCare members that have been processed and accepted for payment by MaineCare.

C. "MaineCare supplemental data form" means a form submitted by hospitals on a template provided by the department that contains information supplemental to the as-filed Medicare cost report necessary for computing the prospective interim payment, including, but not limited to, data pertaining to hospital-based physicians, laboratory and radiology claims and 3rd-party payments.

2. Interim settlement payments. With respect to services provided to MaineCare members performed after December 31, 2011, the department shall make interim settlement payments, if any, to a hospital no later than 12 months following the department's receipt of the hospital's as-filed Medicare cost report and MaineCare supplemental data form.

The interim settlement payment required by this section must be calculated using the same method used when calculating prospective interim payments, except that the data source used for inpatient calculations is discharges and charges included in the MaineCare paid claims history for the year for which settlement is being performed. Any other calculations required in making the interim settlement payment must be based on the hospital's as-filed Medicare cost report, the MaineCare supplemental data form and the MaineCare paid claims history for the year for which settlement is being performed.

summary

This bill requires the Department of Health and Human Services to use current hospital cost reports to calculate amounts owed to hospitals and pay any amounts due within one year of receiving the reports.

HP0628 LD 831	First Regular Session - 125th Maine Legislature		LR 1237 Item 1
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