WAC 388-550-5000   Payment method--Low income disproportionate share hospital (LIDSH).  (1) A hospital that is not a peer group E hospital but serves the department's clients is eligible for a low-income disproportionate share hospital (LIDSH) payment adjustment if the hospital meets the requirements of WAC 388-550-4900(5).

     (2) Hospitals considered eligible under the criteria in subsection (1) of this section receive LIDSH payments. The total LIDSH payment amounts equal the funding set by the state's appropriations act for LIDSH. The amount that the state appropriates for LIDSH may vary from year to year.

     (3) The department determines LIDSH payments to each LIDSH eligible hospital using three factors:

     (a) The hospital's medicaid inpatient utilization rate (MIPUR);

     (b) The hospital's medicaid case mix index (CMI) as determined by the department; and

     (c) The hospital's Title XIX medicaid discharges for the applicable hospital fiscal year.

     (4) The department calculates the LIDSH payment to an eligible hospital as follows. The department:

     (a) Divides the hospital's MIPUR by the average MIPUR of all LIDSH-eligible hospitals; then

     (b) Multiplies the result derived in subsection (a) by the hospital's most recent DRG payment method medicaid case mix index, and then by the hospital's base year Title XIX discharges; then

     (c) Converts the product to a percentage of the sum of all such products for individual hospitals; and

     (d) Multiplies this percentage by the legislatively appropriated amount for LIDSH.

     (5) For DSH program purposes, a hospital's medicaid CMI is the average diagnosis related group (DRG) weight for all of the hospital's medicaid DRG-paid claims during the state fiscal year used as the base year for the DSH application. It is possible that the CMI the department uses for DSH calculations will not be the same as the CMI the department uses in other hospital rate calculations.

     (6) After each applicable state fiscal year has ended, the department will not make changes to the LIDSH payment distribution that has resulted from calculations identified in subsection (4) of this section. The department will recalculate the LIDSH payment distribution only when the applicable state fiscal year has not yet ended at the time the alleged need for an LIDSH adjustment is identified, and if the department considers the recalculation necessary and appropriate under its regulations.

     (7) Consistent with the provisions of subsection (6) of this section, the department applies any adjustments to the DSH payment distribution required by legislative, administrative, or other state action, to other DSH programs in accordance with the provisions of WAC 388-550-4900 (13) through (16).



[Statutory Authority: RCW 74.08.090, 74.09.500. 07-14-090, § 388-550-5000, filed 6/29/07, effective 8/1/07; 06-08-046, § 388-550-5000, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.035(1), and43.88.290 . 03-13-055, § 388-550-5000, filed 6/12/03, effective 7/13/03. Statutory Authority: RCW 74.08.090, 74.09.730 and 42 U.S.C. 1396r-4. 99-14-040, § 388-550-5000, filed 6/30/99, effective 7/1/99. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200,[74.09.]500 , [74.09.]530 and 43.20B.020. 98-01-124, § 388-550-5000, filed 12/18/97, effective 1/18/98.]