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7 AAC 150.180. Methodology and criteria for additional payments as a disproportionate share hospital. (a) A qualifying hospital that provides services to a disproportionate share of low-income patients with special needs is eligible for Medicaid payments as a disproportionate share hospital (DSH). These payments are in addition to the Medicaid payment rate established under 7 AAC 150.160 or 7 AAC 150.190. The department will not award payments under this section to a qualifying hospital in a total amount that exceeds the facility-specific limit calculated under (e)(3) of this section. (b) To qualify for additional payments under this section as a DSH, a hospital must meet the following criteria for each qualifying year:

(1) the hospital must be a general acute care hospital, a critical access hospital, a specialty hospital, or an inpatient psychiatric hospital;

(2) unless it qualifies for the exception set out in 42 U.S.C. 1396r-4(d)(2), the hospital must meet the obstetrical staffing requirements of 42 U.S.C. 1396r-4(d), and must provide the names and Medicaid provider numbers of at least two obstetricians who meet the requirements of that section;

(3) the hospital must have a minimum Medicaid utilization rate of not less than one percent for the qualifying year; for purposes of this paragraph, the Medicaid utilization rate is calculated by dividing the hospital’s number of Medicaid-eligible inpatient days by the hospital’s total number of inpatient days provided to all patients;

(4) not later than October 1 of the calendar year that precedes the payment period, the hospital must submit to the department the following forms and documentation:

(A) the Medicare cost report filed for the qualifying year;

(B) Medicaid reporting forms for the qualifying year from the Medicaid Hospital and Long-Term Care Facility Reporting Manual, adopted by reference in 7 AAC 160.900, including the audited financial statements for the facility;

(C) an uninsured care log for the qualifying year for each patient having uninsured care; the log must be prepared and submitted in electronic spreadsheet format using the Medicaid Log of Uninsured Care Reporting Form, adopted by reference in 7 AAC 160.900; the hospital must certify the log as accurate in an electronic attachment with the submission of the uninsured care log; with respect to uninsured care, the log must specify, in sufficient detail for the department to verify the information,