346G-10 Private hospital payments through enhanced rates to medicaid managed care health plans. [See Note at chapter heading.] (a) The department shall use moneys solely from the hospital sustainability program special fund to fulfill the requirements of section 346G-4(c).

(b) In accordance with title 42 Code of Federal Regulations part 438, the department shall use revenues from the hospital sustainability fee and federal matching funds to enhance the capitated rates paid to medicaid managed care health plans for state fiscal years 2017-2018 and 2018-2019, consistent with the following objectives:

(1) The rate enhancement shall be used exclusively for increasing reimbursements to private hospitals to support the availability of services and to ensure access to care to the medicaid managed care health plan enrollees;

(2) The rate enhancement shall be made part of the monthly capitated rates by the department to medicaid managed care health plans, which shall provide documentation to the department and the hospital trade association located in Hawaii certifying that the revenues received under paragraph (1) are used in accordance with this section;

(3) The rate enhancement shall be actuarially sound and approved by the federal government for federal fund participation;

(4) The rate enhancements shall be retroactive to July 1, 2012, or the effective date approved by the federal government, whichever is later. Retroactive rate enhancements shall be paid within thirty days of notification by the Centers for Medicare and Medicaid Services to the department of all necessary approvals; and

(5) Payments made by the medicaid managed care health plans shall be made within thirty business days upon receipt of monthly capitation rates from the department.

(c) If federal approval pursuant to section 346G-7 is not received until after the end of any month for which the hospital sustainability fee is applicable, the department shall make the initial monthly payments within five days after receipt of the hospital sustainability fee for the respective month.

(d) To the extent the hospital sustainability program is not effective for the entire year, the hospital sustainability fee, the state medicaid expenses and administrative fee, and the corresponding medicaid managed care health plan payments shall be based on the proportion of the fiscal year the program is in effect. [L 2012, c 217, pt of 2, 5; am L 2013, c 141, pt of 1, 2; am L 2014, c 123, 1(3), (4), 2; am L 2015, c 70, 1(5), 2; am L 2016, c 60, 2(5), 3; am L 2017, c 59, 4, 5; am L 2018, c 18, 22]



Previous Vol07_Ch0346-0398 Next