HCA Revises Reporting to Enable Additional Medicare DSH Payments

December 3, 2014

The Health Care Authority (HCA) has completed changes that should help many hospitals obtain significant additional Medicare disproportionate share hospital funding.

WSHA became aware that HCA’s process for counting and reporting Medicaid days for the period from January 1, 2011 through December 2013 did not include days for patients covered by Basic Health and Disability Lifeline funded as part of the expansion waiver under Section 1115 of the Social Security Act. These days are important as they, along with other Medicaid days, factor into the disproportionate share hospital (DSH) component of the Medicare payment rates for prospective payment hospitals. At WSHA’s urging, HCA corrected its process and the data and is now able to provide corrected DSH Reporting Data File reports. Hospitals can amend or reopen their Medicare cost reports for the relevant periods to include the additional days, which will eventually flow through as enhanced Medicare payments. WSHA estimates the total benefit in additional Medicare payment to Washington hospitals could be at least ten million dollars.

Hospitals needing corrected reports and verification letters should contact HCA at HCADSHAdmin@HCA.wa.gov with “DRDF/Prior Period Match“ in the subject line. The process for correcting Medicare cost reports through Noridian will vary by hospital due to differences in reporting periods. More information is available in our previous Bulletin. (Andrew Busz, andrewb@wsha.org

Hospital Presumptive Eligibility Coming in January of 2015

The HCA will be implementing “Hospital Presumptive Eligibility” for Apple Health Enrollment in January. WSHA members asked HCA to do this, and the agency has now gotten approval from CMS to move forward.
Hospital Presumptive Eligibility allows a hospital to enroll someone in Medicaid for up to 60 days with minimal information from the client. For example, if a client does not know their tax filing status, hospitals can enroll through this process. Or if there is a glitch preventing enrollment using the Washington Healthplanfinder website, a hospital can enroll someone immediately via this process.   
HCA will offer trainings in January 2015 for any hospital that registers for the training by December 19, 2014. The training will be available online after January. Once staff have been trained and hospitals sign a contract with the HCA, hospitals can begin enrolling people in Apple Health using Hospital Presumptive Eligibility. For more information, please see these documents from the Health Care Authority or contact Barbara Gorham, WSHA Policy Director, Access (barbarag@wsha.org or 206-216-2512).

Your Help Needed to Fight Proposed Hospital Clinic Cuts

As part of the process to develop a budget proposal for the upcoming biennium (State Fiscal Years 2016 and 2017), the HCA’s recommendations to the Governor included a cut to the Medicaid payment rates for hospital-based clinics of $42 million over the two-year period. (See a hospital-specific estimate of the impact of this cut.) While we do not know if the Governor will include these in his budget, the agency’s recommendations mean they are likely to be discussed seriously during the upcoming session by some legislators.

To help WSHA explain why these payments are needed, WSHA needs better data from hospitals with clinics on the types of services offered and the impact that cuts will have on your community. In the next few days you will receive a brief survey from us so we can be better prepared to maintain hospital payments. We are asking that the survey be completed by December 19, 2014. (Andrew Busz, andrewb@wsha.org)

State’s Revenue Projections Increase, But State Budget Issues Loom

According to a presentation to the Economic and Revenue Forecast Committee, the state will collect $241 million in additional revenue for the 2015-2017 biennium beyond what was originally projected. Unfortunately, the additional revenue amount is dwarfed by the additional obligations the legislature will likely need to fund, which include increased caseloads, education investments due to the McCleary decision and Initiative 1351, and other urgent policy needs, including funding increases to inpatient psychiatric hospital beds.

The Committee’s forecast will be used by Governor Inslee to form his proposed 2015-2017 budget. It is unclear how policymakers will address the difference between available revenue and funding needs during the upcoming legislative session. For one organization’s view, see this analysis from the Washington Budget and Policy Center. (Andrew Busz, andrewb@wsha.org)

HCA, DSHS Move Forward on Care Transformation

The state is still waiting to hear if its grant submittal for $90 million in federal funds for transforming care in Washington will be approved by the federal government. In the meantime, the state is moving forward on its own to transform care through integrating behavioral health and Medicaid. 

On November 20, senior staff from HCA and the Division of Social and Health Services shared with legislators a presentation detailing the current status and future plans for the state’s Medicaid purchasing efforts. The presentation included updates and details regarding on:

  • Regional Service Areas Designation
  • Integrating Behavioral & Physical Healthcare
  • Early Adopter Implementation & Rate Development

 (Claudia Sanders, claudias@wsha.org)


Contact Us

Washington State Hospital Association
999 Third Avenue
Suite 1400
Seattle, WA 98104

Map / Directions

206.281.7211 phone
206.283.6122 fax


Staff List