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PubMed1985

Medicaid program; imposition of cost sharing charges under Medicaid--HCFA. Final rule.

This final rule responds to the comments we received on a final rule with comment period published on February 8, 1983 (48 FR 5730). That rule set forth revised requirements concerning the imposition of cost sharing charges on Medicaid recipients when they receive medical services covered by Medicaid.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1986

Medicare and Medicaid; payment for the cost of malpractice insurance--HCFA. Interim final rule with comment period.

In this final rule we are adopting an apportionment methodology for determining reasonable cost reimbursement for hospital malpractice insurance costs. The new apportionment policy for hospitals will divide total malpractice insurance premium cost into two components. The "administrative component," which accounts for 8.5 percent of total premium cost, will be included in the General and Administrative cost center and will be apportioned on the basis of the individual hospital's Medicare utilization rate. The "risk component," which comprises 91.5 percent of total cost, will be apportioned on the basis of a formula that takes into account the individual hospital's utilization as well as the national Medicare patient utilization rate and the national Medicare malpractice loss ratio (as adjusted to account for associated claims handling costs). Effectively, the "scaling factor formula" will relate the national utilization rate to the adjusted national loss ratio. As a hospital's own utilization rate exceeds or falls below the national utilization rate, the risk component will be reimbursed on the basis of a "scaling factor" that is more or less than the national Medicare malpractice loss ratio. Different apportionment policies are being adopted for Medicare skilled nursing facilities and for providers of services under the Medicaid and Maternal and Child Health programs. This final rule replaces our current apportionment policy for reimbursement of malpractice insurance costs and is applicable, subject to the rules of reopening and administrative finality, to cost reporting periods beginning on or after July 1, 1979.

Cost Allocation↗
PubMed1986

Medicare program; hospital-based skilled nursing facility cost limits effective for cost reporting periods beginning October 1, 1982, and July 1, 1984--HCFA. Final notice.

This schedule of limits revises the single Medicare reimbursement limit that was published in the Federal Register (47 FR 42894) on September 29, 1982 insofar as that notice applied to hospital-based skilled nursing facility (SNF) inpatient routine service costs. Freestanding SNF cost limits are not affected by this notice.

Cost Allocation↗
PubMedDate not supplied

Relate hospital charges to use of services.

Despite their constantly rising charges that provoke government regulators and insurance companies to impose "caps," hospitals and other health care institutions continue to use antiquated cost control systems. This author describes a new accounting system, based on the amount of care each patient needs, that has been in use at Massachusetts Eye and Ear Infirmary for six years. In this system, basic "clinical care units" (determined by a peer review process and in collaboration with third-party payers) establish the acceptable standard for a given diagnosis. With charges and reimbursement based more directly on the labor and services involved, hospitals can plan more efficient use of nursing staff and other personnel and services. Use of established norms for each diagnosis also helps staff and third-party insurers determine when hospital resources are being used most productively.

Accounting↗