(1) All private hospitals, except those exempted under section 56-1408, Idaho Code, shall make payments to the fund in accordance with this chapter. Subject to section 56-1410, Idaho Code, an annual assessment on both inpatient and outpatient services is determined for each qualifying hospital for each state fiscal year in an amount calculated by multiplying the rate, as set forth in subsections (2)(c) and (3)(b) of this section, by the assessment base, as set forth in subsection (5) of this section.
(2)(a)  The department shall calculate the private hospital upper payment limit gap for both inpatient and outpatient services. The upper payment limit gap is the difference between the maximum allowable payments eligible for federal match, less medicaid payments not financed using hospital assessment funds. The upper payment limit gap shall be calculated separately for hospital inpatient and outpatient services. Medicaid disproportionate share payments shall be excluded from the calculation.
(b)  Idaho medicaid will start work toward approval by the centers for medicare and medicaid services (CMS) of an updated upper payment limit calculation methodology no later than July 1, 2022. This change is needed due to the change reflected in section 56-265, Idaho Code, in reimbursement from retrospective cost settlements to prospective payment systems.
(c)  The department shall calculate the upper payment limit assessment rate for each state fiscal year to be the percentage that, when multiplied by the assessment base as defined in subsection (5) of this section, equals the upper payment limit payment.
(d)  Beginning July 1, 2022, or upon approval by CMS, whichever is later, the assessment rate referenced in paragraph (c) of this subsection will increase to the amount needed to attain an increased supplemental upper payment limit payment. This payment amount is subject to CMS approval of the updated upper payment limit methodology described in paragraph (a) of this subsection and legislative appropriation.
(e)  Beginning July 1, 2023, an additional amount will be assessed at thirty percent (30%) of the upper payment limit payment to be utilized for general fund medicaid needs.
(f)  If CMS does not approve the updated upper payment limit methodology described in paragraph (b) of this subsection, then the additional assessment described in paragraph (e) of this subsection shall not be implemented.
(g)  The assessment described in paragraph (e) of this subsection shall be assessed only if the upper payment limit payment is greater than the total assessment.
(3)(a)  The department shall calculate the disproportionate share allotment amount to be paid to private in-state hospitals.
(b)  The department shall calculate the disproportionate share assessment rate for private in-state hospitals to be the percentage that, when multiplied by the assessment base as defined in subsection (5) of this section, equals the amount of state funding necessary to pay the private in-state hospital disproportionate share allotment determined in paragraph (a) of this subsection.
(4)  For private in-state hospitals, the assessments calculated pursuant to subsections (2) and (3) of this section shall not be greater than the federal limit as referenced in 42 C.F.R. § 433.68 of the assessment base as defined in subsection (5) of this section.
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Terms Used In Idaho Code 56-1404

  • Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
  • Department: means the department of health and welfare. See Idaho Code 56-1402
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Hospital: is a s defined in section 39-1301(a), Idaho Code. See Idaho Code 56-1402
  • Private hospital: means a hospital that is not owned by a governmental entity. See Idaho Code 56-1402
  • State: when applied to the different parts of the United States, includes the District of Columbia and the territories; and the words "United States" may include the District of Columbia and territories. See Idaho Code 73-114
  • Upper payment limit: means a limitation established by federal regulations, 42 C. See Idaho Code 56-1402
(5)  The assessment base shall be the hospital’s net patient revenue for the applicable period. Net patient revenue, beginning with state fiscal year 2023, shall be determined using each hospital’s fiscal year 2021 medicare cost report on file with the department, without regard to any subsequent adjustments or changes to such data. If the 2021 cost report has not been filed, the prior year’s cost report will be used. Net patient revenue for each state fiscal year thereafter shall be determined in the same manner using a rolling yearly schedule for each hospital’s fiscal year medicare cost report.