Hospitals in 16 Indiana Counties Qualify for Higher Medicare IPPS Payment

In the June 2, 2010 updated CMS IPPS Proposed rules for FY2011, increased payment was described for hospitals in counties with the lowest per capita Medicare spending (lowest quartile).

Counties in Indiana that qualified are:

• Adams
• Brown
• DeKalb
• Elkhart
• Franklin
• Huntington
• Jackson
• Kosciusko
• LaGrange
• Marshall
• Monroe
• Noble
• Orange
• Wabash
• Wells
• Whitley

The following is excerpt of text from the proposed rule. You can read the complete proposed rules at the following: http://edocket.access.gpo.gov/2010/pdf/2010-12567.pdf (starts on page 30926)

E. Additional Payments for Qualifying Hospitals With Lowest Per Capita Medicare Spending

1. Background
Section 1109 of Public Law 111–152, provides for additional payments for FY2011 and 2012 for ‘‘qualifying hospitals.’’ Section 1109(d) defines a ‘‘qualifying hospital’’ as a ‘‘subsection (d) hospital * * * that is located in a county that ranks, based upon its ranking in age, sex and race adjusted spending for benefits under parts A and B * * * per enrollee within the lowest quartile of such counties in the United States.’’ Therefore, a ‘‘qualifying hospital’’ is one that meets the following conditions: (1) A ‘‘subsection (d) hospital’’ as defined in section 1886(d)(1)(B) of the Act; and (2) located in a county that ranks within the lowest quartile of counties based upon its spending for benefits under Medicare Part A and Part B per enrollee adjusted for age, sex, and race. Section 1109(b) of Public Law 111–152 makes available $400 million to qualifying hospitals for FY 2011 and FY 2012. Section 1109(c) of Public Law 111–152 requires the $400 million to be divided among each qualifying hospital in proportion to the ratio of the individual qualifying hospital’s FY 2009 IPPS operating hospital payments to the sum of total FY2009 IPPS operating hospital payments made to all qualifying hospitals.