While New Hampshire's approved formula would, for the first time recognize some of the costs of treating uninsured patients, it will continue to impose burdens on hospitals, Ahnen, said. "In turn, communities and patients suffer because of the strain on the health care infrastructure," he said.
"Hospitals in New Hampshire, particularly those who provide uncompensated care, pay a tax at 5.5 percent of net services. I don't know how the state has been able to take these funds and put them into the General Fund, because the hospitals are not being compensated at the level intended by this federal program," Ahnen said.
"The concerns raised by New Hampshire's hospitals over this practice are genuine, significant and continuing. While we understand the proposal will likely move forward, NHHA remains committed to working in the best interests of the patients and communities served by New Hampshire's hospitals," he said.
New Hampshire Health and Human Services Commissioner Nicholas Toumpas said the plan, which still needs CMS' approval, will be revised in the coming months. The differences between the earlier plan and the new one, Toumpas said, is that there cannot be a "hold harmless provision" for what hospitals pay under the Medicaid Enhancement Tax (MET), a hospital assessment levied by the state, based on a hospital's revenue.
Historically, the state used the proceeds from the tax to make DSH payments to hospitals. The state then filed a claim with the federal government for the DSH payment and received matching funds that were about 50 percent of the state's share of the funding, Toumpas said. Those matching funds were designed to further support uncompensated care and make payments to hospitals that qualified for the DSH program.
"The [New Hampshire] hospitals were told that they needed to change the program to be compliant," Toumpas said. "They're doing this to comply with the October 1 change."