40-8.3-3. Implementation.

(a) For federal fiscal year 2024, commencing on October 1, 2023, and ending September

30, 2024, the executive office of health and human services shall submit to the Secretary of the

United States Department of Health and Human Services a state plan amendment to the Rhode

Island Medicaid DSH Plan to provide:

(1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of

$14.8 million, shall be allocated by the executive office of health and human services to the Pool

D component of the DSH Plan; and

(2) That the Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care costs for the base year

inflated by the uncompensated-care index for all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2024, and are expressly conditioned upon approval

on or before June 23, 2024, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2024 for the

disproportionate share payments.

(b) (a) For federal fiscal year 2025, commencing on October 1, 2024, and ending on

8 September 30, 2025, the executive office of health and human services shall submit to the Secretary

of the United States Department of Health and Human Services a state plan amendment to the

Rhode Island Medicaid DSH plan to provide:

(1) The creation of Pool C which allots no more than twelve million nine hundred thousand

dollars ($12,900,000) to Medicaid eligible government-owned hospitals;

(2) That the DSH plan to all participating hospitals, not to exceed an aggregate limit of

$27.7 million, shall be allocated by the executive office of health and human services to the Pool

C and D components of the DSH plan;

(3) That the Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care costs for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2025, and are expressly conditioned upon approval

on or before June 23, 2025, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2025 for the

disproportionate share payments; and

(4) That the Pool C allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care cost for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2025, and are expressly conditioned upon approval

on or before June 23, 2025, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2025 for the

disproportionate share payments.

(c) (b) For federal fiscal year 2026, commencing on October 1, 2025, and ending on

1 September 30, 2026, the executive office of health and human services shall submit to the Secretary

of the United States Department of Health and Human Services a state plan amendment to the

Rhode Island Medicaid DSH plan to provide:

(1) That the DSH plan to all participating hospitals, not to exceed an aggregate limit of

$13.9 million, shall be allocated by the executive office of health and human services to the Pool

C and D components of the DSH plan. Pool C shall not exceed an aggregate limit of $12.9 million.

Pool D shall not exceed an aggregate limit of $1.0 million;

(2) That the Pool C allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care cost for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2026, and are expressly conditioned upon approval

on or before June 23, 2026, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2026 for the

disproportionate share payments; and

(3) That the Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care costs for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2026, and are expressly conditioned upon approval

on or before June 23, 2026, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2026 for the

disproportionate share payments.

(c) For federal fiscal year 2027, commencing on October 1, 2026, and ending on September

30, 2027, the DSH plan for all participating hospitals shall not exceed an aggregate limit of thirty-

eight million nine hundred thousand dollars ($38,900,000) and shall be allocated by the executive

office of health and human services to the Pool C and D components of the DSH plan. The Pool C

component of the DSH plan shall not exceed an aggregate limit of twelve million nine hundred

thousand dollars ($12,900,000). The Pool D component of the DSH plan shall not exceed an

aggregate limit of twenty-six million dollars ($26,000,000).

(1) The Pool C allotment shall be distributed among the participating hospitals in direct

proportion to each individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index as described in § 40-8.3-2(5). The DSH payments shall

be made on or before June 30, 2027; and,

(2) The Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index as described in § 40-8.3-2(5). The disproportionate share

payments shall be made on or before June 30, 2027.

(e) The executive office of health and human services is directed, on at least a monthly

basis, to collect patient-level uninsured information, including, but not limited to, demographics,

services rendered, and reason for uninsured status from all hospitals licensed in Rhode Island.

13 (f) [Deleted by P.L. 2019, ch. 88, art. 13, § 6.]

SECTION 4. Section 40-8.5-1 of the General Laws in Chapter 40-8.5 entitled "Health Care

for Elderly and Disabled Residents Act" is hereby amended to read as follows: