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PDFWAC 182-550-4650

"Full cost" public hospital certified public expenditure (CPE) payment program.

(1) The medicaid agency's "full cost" public hospital certified public expenditure (CPE) inpatient payment program provides payments to participating government-operated hospitals based on the "full cost" of covered medically necessary services and requires the expenditure of local funds in lieu of state funds to qualify for federal matching funds. The agency's inpatient payments to participating hospitals equal the federal matching amount for allowable costs. The agency uses the ratio of costs-to-charges (RCC) method described in WAC 182-550-4500 to determine "full cost."
(2) To be eligible for the "full cost" public hospital CPE payment program, the hospital must be:
(a) Operated by a public hospital district in the state of Washington, not certified by the department of health (DOH) as a critical access hospital, and has not chosen to opt-out of the CPE payment program as allowed in subsection (6) of this section;
(b) Harborview Medical Center; or
(c) University of Washington Medical Center.
(3) Payments made under the inpatient CPE payment program are limited to medically necessary services provided to medical assistance clients eligible for inpatient hospital services.
(4) Each hospital described in subsection (2) of this section is responsible to provide certified public expenditures as the required state match for claiming federal medicaid funds.
(5) The agency determines the initial payment for inpatient hospital services under the CPE payment program by:
(a) Multiplying the hospital's medicaid RCC by the covered charges (to determine allowable costs), then;
(b) Subtracting the client's responsibility and any third party liability (TPL) from the amount derived in (a) of this subsection, then;
(c) Multiplying the state's federal medical assistance percentage (FMAP) by the amount derived in (b) of this subsection. If the state's applicable FMAP is zero percent, the amount derived in (b) of this subsection is multiplied by the lowest Washington state-specific medicaid FMAP in effect at the time of claim payment.
(6) A hospital may opt-out of the inpatient CPE payment program if the hospital:
(a) Meets the criteria for the inpatient rate enhancement under RCW 74.09.5225; or
(b) Is not eligible for public hospital disproportionate share hospital (PHDSH) payments under WAC 182-550-5400.
(7) To opt-out of the inpatient CPE payment program, the hospital must submit a written request to opt-out to the agency's chief financial officer by July 1st in order to be effective for January 1st of the following year.
(8) Hospitals participating in the inpatient CPE payment program must complete the applicable CPE medicaid cost reports as described in WAC 182-550-5410 for the inpatient fee-for-service cost settlements.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-10-048, § 182-550-4650, filed 4/24/24, effective 5/25/24; WSR 22-09-079, § 182-550-4650, filed 4/20/22, effective 5/21/22. Statutory Authority: RCW 41.05.021, 41.05.160, and 74.09.5225(3). WSR 15-11-009, § 182-550-4650, filed 5/7/15, effective 6/7/15. Statutory Authority: RCW 41.05.021 and 42 C.F.R. 433.51(b). WSR 12-04-022, § 182-550-4650, filed 1/25/12, effective 2/25/12. WSR 11-14-075, recodified as § 182-550-4650, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 06-08-046, § 388-550-4650, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 05-12-132, § 388-550-4650, filed 6/1/05, effective 7/1/05.]
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