Modifying Certain Limitations on Disproportionate Share Hospital Payment Adjustments under the Medicaid Program
Section 6106 · Sec. 6106 ·
What this chapter is about
This part changes how a cap on hospital aid payments is worked out. It counts other payers when it counts what a hospital was paid. It also lets a state use money it did not spend in past years, up to the new cap.
The document says “is amended”Who acts: CongressHow: statuteSec. 6106 in the PDF
What the document says
“``(III) payments made under title XVIII or by an applicable plan (as defined in section 1862(b)(8)(F)) for such services.''”
Section 6106 adds a new subclause (III) to section 1923(g)(1)(A)(ii) of the Social Security Act, adding payments made under title XVIII, the Medicare title, or by an applicable plan as defined in section 1862(b)(8)(F), to what is counted for the payment adjustment limit.
What the document actually says
“``(III) payments made under title XVIII or by an applicable plan (as defined in section 1862(b)(8)(F)) for such services.''”
That sentence, in plain words
Count what other payers paid for the same care. That means one big federal health plan and certain other plans.
What this is about
The cap is worked out from what a hospital spent and what it was paid. Adding a payer to that count lowers the gap the cap allows.
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The document says “is amended”Who acts: CongressHow: statuteSec. 6106 in the PDF
What the document says
“``(iii) Individuals who are eligible for medical assistance under the State plan or under a waiver”
Section 6106 adds a new clause (iii) to section 1923(g)(1)(B) of the Social Security Act. It covers individuals eligible for medical assistance under the State plan or a waiver for whom the plan or waiver pays after Medicare or an applicable plan, but only if the hospital in the aggregate incurred costs exceeding the payments from all of those sources for services furnished to those individuals during the year.
What the document actually says
“``(iii) Individuals who are eligible for medical assistance under the State plan or under a waiver”
That sentence, in plain words
This covers people who can get help under the state plan or a waiver of it.
What this is about
These are people with more than one payer. The hospital may count them only if its costs were more than all it was paid for them.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “is amended”Who acts: CongressHow: statuteSec. 6106 in the PDF
What the document says
“(2) by striking paragraph (2);
(3) by redesignating paragraph (3) as paragraph (2); and”
Section 6106 strikes paragraph (2) of section 1923(g) of the Social Security Act, redesignates paragraph (3) as paragraph (2), and in the redesignated paragraph strikes the words carrying over the old cross reference so that it reads simply Paragraph (2).
What the document actually says
“(2) by striking paragraph (2);
(3) by redesignating paragraph (3) as paragraph (2); and”
That sentence, in plain words
Take out one numbered part. Give the next part that number.
What this is about
Taking a part out leaves a hole in the count. Renumbering closes it. Then the words that pointed at the old part have to change too.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall apply”Who acts: States, Secretary of Health and Human ServicesHow: statuteSec. 6106 in the PDF
What the document says
“the amendments made by this section shall apply to payment adjustments made under section 1923 of the Social Security Act (42 U.S.C. 1396r-4) for Medicaid State plan rate years beginning on or after the date of enactment of this Act.”
Subsection (b) of section 6106 provides that, except as its second paragraph provides, the amendments apply to payment adjustments for Medicaid State plan rate years beginning on or after the date of enactment.
What the document actually says
“the amendments made by this section shall apply to payment adjustments made under section 1923 of the Social Security Act (42 U.S.C. 1396r-4) for Medicaid State plan rate years beginning on or after the date of enactment of this Act.”
That sentence, in plain words
The changes count for rate years that start on or after the day this law passed.
What this is about
A rate year is the year a state uses to set what it pays. Tying the change to it keeps a year from being split in two.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“the State may use the unspent portion of such allotment to increase the amount of any payment adjustment made to a hospital for such rate year”
Paragraph (2) of subsection (b) lets a State that did not spend its full federal allotment for a rate year beginning on or after October 1, 2022 and before enactment use the unspent portion to increase a payment adjustment to a hospital for that rate year. The increased adjustment must be consistent with section 1923(g) as amended, and total adjustments for the rate year must not exceed the State's allotment for the applicable federal fiscal year.
What the document actually says
“the State may use the unspent portion of such allotment to increase the amount of any payment adjustment made to a hospital for such rate year”
That sentence, in plain words
The state may use the money it did not spend. It may use it to raise a payment it made to a hospital for that year.
What this is about
A state can end a year with money left over. This lets that money go out late instead of going back. Two limits still apply.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“A State shall not recoup any payment adjustment made by the State to a hospital for a Medicaid State plan rate year described in subparagraph (A) if such payment adjustment is consistent with section 1923(g) of such Act (42 U.S.C. 1396r-4(g)) as in effect on October 1, 2021.”
Subparagraph (B) bars a State from recouping a payment adjustment made to a hospital for one of those prior rate years, if the adjustment was consistent with section 1923(g) of the Social Security Act as in effect on October 1, 2021.
What the document actually says
“A State shall not recoup any payment adjustment made by the State to a hospital for a Medicaid State plan rate year described in subparagraph (A) if such payment adjustment is consistent with section 1923(g) of such Act (42 U.S.C. 1396r-4(g)) as in effect on October 1, 2021.”
That sentence, in plain words
A state may not take back money it paid a hospital for one of those years. That holds if the payment fit the rule as it stood on October 1, 2021.
What this is about
To recoup is to take money back after paying it. A hospital that followed the old rule keeps what it got.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “can”Who acts: States, Secretary of Health and Human ServicesHow: statuteSec. 6106 in the PDF
What the document says
“a State may retroactively modify a provision of the Medicaid State plan, a waiver of such plan, or a State plan amendment that relates to such rate year and the Secretary may approve such modification.”
Subparagraph (C) allows a State, solely to increase a payment adjustment under this paragraph, to modify a State plan provision, waiver or plan amendment for a prior rate year retroactively, and allows the Secretary to approve it. A request may not be submitted after the date the State must submit the independent certified audit for that rate year under section 1923(j)(2) of the Social Security Act.
What the document actually says
“a State may retroactively modify a provision of the Medicaid State plan, a waiver of such plan, or a State plan amendment that relates to such rate year and the Secretary may approve such modification.”
That sentence, in plain words
A state may go back and change part of its plan for that year. The health chief may say yes to the change.
What this is about
A state plan sets how money goes out. To pay more, the plan may need to change first. The change has a cutoff, tied to the year's audit.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“the State shall include information in such form and manner as the Secretary shall specify on such increased payment adjustment as part of the annual report submitted by the State under section 1923(j)(1) of the Social Security Act (42 U.S.C. 1396r-4(j)(1)) for such State plan rate year”
Subparagraph (D) requires a State that increases a payment adjustment under this paragraph to report on it, in the form and manner the Secretary specifies, as part of its annual report under section 1923(j)(1) of the Social Security Act for that rate year, or if the Secretary determines it necessary, in an amendment to that report.
What the document actually says
“the State shall include information in such form and manner as the Secretary shall specify on such increased payment adjustment as part of the annual report submitted by the State under section 1923(j)(1) of the Social Security Act (42 U.S.C. 1396r-4(j)(1)) for such State plan rate year”
That sentence, in plain words
A state that raises a payment must report it. The report goes in the yearly one it already files. The health chief says what form to use.
What this is about
States already file a yearly report on these payments. This adds the late raises to it. That keeps the count in one place.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The main things the section does: add other payers to what counts against the cap, add a new clause covering individuals for whom the State plan pays after other coverage, strike and redesignate two paragraphs, set the effective date, and give States an option to distribute unspent allotments from prior years with its conditions.
The mechanical amendments moving the word and, a period and a semicolon between subclauses.
The section amends section 1923 of the Social Security Act and points at section 1862(b)(8)(F) of that Act. It is not indexed here, so how the cap otherwise works is not recorded on this site.
