1. Healthcare Association of New York Statewww.hanys.org Bob McLeod March 12, 2015

2. Healthcare Association of New York Statewww.hanys.org Agenda NYS Hospital Financial Assistance Law compared to IRS Final Rule 501(r), Indigent Care Pool, and 2012 Medicaid DSH audit 0bjectives and Timeline

3. Healthcare Association of New York Statewww.hanys.org

4. Healthcare Association of New York Statewww.hanys.org Why such a focus on charity care (financial assistance) and collections? Some policy makers believe that charity care is the most important community benefit. Concerns regarding some patient experiences with the collections process: – Discouraging uninsured patients from seeking or obtaining care at tax-exempt hospitals. – Leaving patients with excessive medical debt. – Hospitals willing to offer greater discounts to commercial insurers than to low-income patients. Lobbying by consumer advocates. Source: Verite Healthcare Consulting, LLC 2015

5. Healthcare Association of New York Statewww.hanys.org Brief History and Context IRS 501 (r) Concerns about tax- exempt hospitals 2007: Redesigned form 990 and Schedule H 2010: ACA “501(r)” requirements Dec 2014: 501(r) Final Rule Source: Verite Healthcare Consulting, LLC 2015

6. Healthcare Association of New York Statewww.hanys.org The Affordable Care Act – March 2010 Added 501(r) to the Internal Revenue Code: – Standards for conducting and publishing a Community Health Needs Assessment (CHNA); – Establishment and disclosure of financial assistance policies; – Limitations on amounts charged to patients who are eligible for financial assistance; and – Rules governing billing and collections practices. Compliance with the Final Rule must occur by the beginning of Tax Years on/after December 29, 2015 (Final Rule – Dec 2014).

7. Healthcare Association of New York Statewww.hanys.org Brief History and Context NYS Hospital Financial Assistant Law (HFAL) Adverse Media Attention on Hospital Billing of the Uninsured 2004: Financial Aid/Charity Care Guidelines 2007: State Budget Mandated HFAL Public Health Law 2807-k(9) 2007-present: DALs and Education Clarifying HFAL 2014: State Audit of Hospital Compliance with HFAL

8. Healthcare Association of New York Statewww.hanys.org Compliance HFAL Originally compliance with the HFAL was required as a condition of participation in Indigent Care Pool distributions on/after January 1, 2009. – Later subject to a fine up to $10,000 per violation. 2014: 1% of Medicaid DSH payments withheld until substantial compliance is determined. IRS 501(r) No sanctions or disclosures apply to errors that are minor and either inadvertent or due to reasonable cause if corrected promptly. Willful non-compliance may result in revoking 501(c)(3) status for hospital facility. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

9. Healthcare Association of New York Statewww.hanys.org Eligibility HFAL At a minimum individuals with household incomes below 300% FPL without insurance or who have exhausted their health insurance benefits. Insured individuals: co- pays and deductibles at the discretion of hospital. Must be reported in FAP. IRS 501(r) No specified eligibility criteria. Although once established by hospital it must be reported in its financial assistance policy (FAP). This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

10. Healthcare Association of New York Statewww.hanys.org Determination of Eligibility/Income HFAL May not be overly burdensome. Only documentation that indicates current income is permitted. The hospital may not require tax returns or monthly bills. IRS 501(r) Requirements must be described in FAP. Individuals may not be denied financial assistance if they do not provide documentation that has not be specified in the FAP. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

11. Healthcare Association of New York Statewww.hanys.org Presumptive Eligibility HFAL Permitted. The hospital may use credit scoring software for purposes of establishing income eligibility and approving financial assistance. – May not require patients to provide social security numbers, and the scoring must not negatively impact the patient’s FICO scores. – Credit scoring software cannot be used to deny applications for financial assistance, and – Language referring to credit scoring should not appear on applications. IRS 501(r) Permitted. Assistance may be grated at less than the most generous level (different from proposed rule). – May apply for more generous assistance. Allowable sources of information besides those provided by individual must be disclosed in FAP. Under what circumstances prior FAP-eligibility may be used must be disclosed in FAP. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

12. Healthcare Association of New York Statewww.hanys.org Financial Assistance Conditional on Medicaid Application HFAL Prohibits a blank requirement. On a case-by-case basis hospitals may require individuals applicants that it believes would be eligible for Medicaid or other public health insurance to cooperate in applying, or that coverage as a condition of receiving financial assistance. – Financial assistance applications must be processed concurrently with any application for public assistance. IRS 501(r) Permitted. Allows the FAP-eligibility determination to be held pending the determination of Medicaid. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

13. Healthcare Association of New York Statewww.hanys.org Covered Services HFAL Emergency Services – All NYS residents at a minimum. Non-emergent, medically necessary services to residents in a hospital’s primary service area at a minimum. – While DOH establishes the hospitals primary service area, the hospital may provide financial assistance to residents beyond this area. – The hospital must disclose the geographic service area within which is FAP will apply. IRS 501(r) All emergency services and other medically necessary care (as applicable under the laws of the state). Must establish an emergency medical care policy that : – Prohibits it from actions that discourage individuals from seeking emergency care such as demanding payment before receiving treatment or permitting debt collection activities. No reference to service area requirements. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

14. Healthcare Association of New York Statewww.hanys.org Providers Covered by the Hospital’s FAP HFAL Disclosure is not required. IRS 501(r) The hospital must list providers, other than the hospital itself, delivering emergency or other medically necessary care in the hospital that are covered and not covered by the hospital’s FAP. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

15. Healthcare Association of New York Statewww.hanys.org Publicizing the FAP HFAL The hospital must : – Ensure that its FAP summary and financial aid application are available on the hospital’s website. – Make policy summary available in writing to the public or upon request and in areas where care in provided. – Patients must be notified of the availability and how to obtain financial assistance: During the intake process; Though conspicuous posting of the information in appropriate areas of the hospital; and On billing statements. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

16. Healthcare Association of New York Statewww.hanys.org Publicizing the FAP - Continued IRS 501(r) Hospital must: – Make available on its website the FAP, FAP application form and the plain language summary (PLS) of the FAP; – Make available paper copies available upon request in public locations and by mail (ER and admitting at a minimum); – Notify and inform members of the community “in a manner reasonably calculated to reach those members who are most likely to require financial assistance from the hospital facility.”; and – Notify and inform individuals who receive care from the hospital facility about the FAP: Paper copy PLS at intake/discharge; Billing statement; and Conspicuous posting (ER and admitting at a minimum). This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

17. Healthcare Association of New York Statewww.hanys.org Language Requirement HFAL Applications must be available in the primary languages of individuals that use the hospital services. – 5% of languages used during patient visits annually; or – Languages spoken by at least 1% of the total population of the hospital’s service area. IRS 501(r) The FAP, FAP application, and PLS must be translated into the primary language spoken by limited English proficiency (LEP) language groups that constitute the lesser of: – 1,000 people or – 5% of the community serviced. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

18. Healthcare Association of New York Statewww.hanys.org Cap on Fees HFAL Specifies the maximum payment amounts (MPA) for the mandated eligible population(at or below 300% FPL) based on payments from either Medicare, Medicaid, or the highest volume commercial payer:  Individuals at or below 100%FPL may be charged no more than a nominal amount based on care provided;  Individuals between 101%-150% FPL sliding scale from a nominal amount up to 20% of the MPA;  Individuals between 151%-250% sliding scale from 20% up to 100% of MPAl; and  Individuals between 251%-300% FPL no more than at MPA. The hospital may use different discounting methods for inpatient and outpatient services. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

19. Healthcare Association of New York Statewww.hanys.org Cap on Fees - Continued IRS 501(r) Specifies the maximum amount collected from FAP-eligible individuals for emergency or medically necessary care is limited to the amount generally billed (AGB) insured patients. Two methods for calculating AGB may be used: – “Look-back” method, or – “prospective” method The FAP must state the method of determining AGB. Hospital may change the method as long as it incorporates the change into the FAP before implementing. Organizations having multiple hospitals may have different AGBs/methods of calculated AGB for each hospital. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

20. Healthcare Association of New York Statewww.hanys.org Cap on Fees - Continued IRS 501(r) “Look-back” method – Calculate at least annually. – Formula: 12-months allowed claims/associated gross charges (all claims, not only medically necessary); – Hospital may use: Medicare fee-for-service; or Medicare fee-for-services and all private health insures; or Medicaid; or Medicaid and all private payers – May be one or multiple (service-specific) percentages. – Must be applied by the 120 th day after the 12-month period. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

21. Healthcare Association of New York Statewww.hanys.org Cap on Fees - Continued IRS 501(r) “Prospective” Medicare or Medicaid method – Use the Medicare fee-for-service or Medicaid billing and coding process to calculate AGB for amounts Medicare/Medicaid would pay (includes any coinsurance amounts that are the patient’s responsibility). This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

22. Healthcare Association of New York Statewww.hanys.org Cap on Fees - Continued IRS 501(r) The hospital must charge the FAP-eligible individual less than gross charges for any medical care (including care not covered by under the hospital’s FAP). The AGB limitation for insured individuals that are FAP- eligible is applied only to the amount that the individual is personally liable for after all payments from the insurer has been applied. – Therefore the combined amount paid to the hospital by the FAP- eligible individual and the health insurance may exceed AGB. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

23. Healthcare Association of New York Statewww.hanys.org Cap on Fees - Continued IRS 501(r) Hospital not in violation of IRS 501(r) when charges exceed AGB if: – The charge was not a part of an upfront payment for medically necessary care; – At the time of the charge the individual had not submitted a complete FAP application; and – If the individual is later found to be FAP-eligible the hospital refunds any amount collected over the FAP discounted amount. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

24. Healthcare Association of New York Statewww.hanys.org Cap on Fees - Continued IRS 501(r) “If a hospital facility requires an individual to make an upfront payment for medically necessary care that exceeds the AGB for the care and the individual turns out to be FAP-eligible, the hospital facility will have failed to meet the requirements of 501(r)(5).” This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

25. Healthcare Association of New York Statewww.hanys.org Application Period HFAL Total of 110 days Individuals have at least 90 days from date of discharge to apply. In addition they are provided at least 20 days to submit a completed application including all required documents. IRS 501(r) Total of 240 days. The hospital must wait at least 120 days before initiating certain collection actions The hospital is required to accept applications for an additional 120 days. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

26. Healthcare Association of New York Statewww.hanys.org Eligibility Notification HFAL Hospital must respond in writing with a determination within 30 days from receiving an application. If denied financial assistance, the individual must be provided information on how to appeal the denial. – Hospital’s FAP must outline the appeals process IRS 501(r) Hospital must notify the individual in writing of eligibility determination. If FAP-eligible: – Revised billing statement showing discount and how it was determined; – Provide any refund if applicable; and – Take reasonable efforts to reverse any “extraordinary collection actions” (ECAs) implemented. Incomplete application – provide a written notice that describes the additional information needed; and – give the individual a reasonable opportunity to complete. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

27. Healthcare Association of New York Statewww.hanys.org Billing and Collections HFAL The FAP must contain information about the hospital’s collection practices:  Requirement that contracted collections agencies comply with the hospital’s FAP and provide application information to individuals;  Prohibit the forced sale or foreclosure of individual’s primary residence;  Prohibit sending an account to collection for those individuals who have submitted applications with eligibility determinations still pending; and  Requirement that a written notification be sent to individuals at least 30 days prior to referring the account to collections. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

28. Healthcare Association of New York Statewww.hanys.org Billing and Collections - continued HFAL  Requirement that contracted collections agencies obtain the hospital’s written consent before commencing a legal action; and  Prohibit collections against any individual who was Medicaid eligible at the time care was provided. Hospital staff that interacts with patients, especially those in billing and collections, must receive training about the hospital’s financial assistance policies and procedures. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

29. Healthcare Association of New York Statewww.hanys.org Billing and Collections - continued IRS 501(r) The FAP must contain the hospital’s collection policies unless the hospital has a separate collections policy that meets the law’s requirements. The hospital cannot engage in extraordinary collections actions (ECA) before making a reasonable effort to determine the individual’s FAP eligibility. ECAs include:  Selling an individual’s debt (with some exceptions); and  Reporting adverse information to consumer credit reporting agencies or credit card bureaus. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

30. Healthcare Association of New York Statewww.hanys.org Billing and Collections - continued IRS 501(r) ECAs include (continued):  Deferring, denying or requiring payment before providing medically necessary care to individuals with outstanding bills for previous care; and  Actions that require a legal or judicial process including:  Placing a lien or foreclosing on an individual’s real property;  Attaching or seizing a bank account or other personal property;  Commencing a civil action;  Causing an individual’s arrest or for the individual to be subject to a writ of body attachment; or  Garnishing of wages This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

31. Healthcare Association of New York Statewww.hanys.org Billing and Collections - continued IRS 501(r) At least 30 days before initiating an ECA, the hospital must: – provide the individual with written notice that states the availability of financial assistance and identifies the ECA(s) that the hospital intends to take; – Provide the individual with the plain language summary (PLS) of the FAP; and – Make reasonable efforts to orally notify the individual about the hospital’s FAP. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

32. Healthcare Association of New York Statewww.hanys.org Data Reporting HFAL Schedule 50 of the Institutional Cost Report (ICR). Submission of FAP to DOH. KPMG questionnaire as part of the ICR audit. IRS 501(r) Schedule H of the IRS 990. This document is not intended and should not be considered legal advice. HANYS strongly suggests that hospitals work with their legal advisers to ensure that their financial assistance policy and related documents meet all the requires of these laws.

33. Healthcare Association of New York Statewww.hanys.org NYS Financial Assistance Compliance Pool - HFAL The 2012-13 State Budget as part of the Indigent Care Pool distribution language established the financial assistance compliance pool. Authorizes 1% of Total DSH distributions to be set aside for 2014 and 2015. Total New York State DSH Distributions (excluding OMH hospitals) is $2.64B. 1% of this amount results in a FACP of $26.4M. Pool funds are released back to hospitals upon their demonstrating/achieving substantial compliance with HFAL. 33

34. Healthcare Association of New York Statewww.hanys.org HFAL Substantial Compliance Method for determining substantial compliance is based on achieving a “passing score” on HFAL questionnaire and KPMG review. Achieving a minimum compliance level on questions pertinent to HFAL. For 2014, compliance in 38 of the 46 areas tested on the HFAL questionnaire completed as part of 2012 ICR Audit. Minimum compliance level will increase in 2015, as hospitals will have had time to become closer to total compliance. The standard will be 44 of 49 areas of compliance. 34 Source: NYSDOH

35. Healthcare Association of New York Statewww.hanys.org HFAL Questionnaire Results In 2014, Of the 46 questions presently considered pertinent to HFAL compliance: 9 hospitals were deficient in 9 or more areas, An additional 30 hospitals were deficient in 6-8 areas, An additional 21 hospitals were deficient in 5 areas. Hospitals not achieving substantial compliance will have to submit a corrective action plan and demonstrate substantial compliance by 12/31/15 or their FACP funds will be forfeited and reallocated. 35 Source: NYSDOH

36. Healthcare Association of New York Statewww.hanys.org 2014 Questionnaire Reponses Top 5 Areas of Non-Compliance with HFAL Question #Question Description Number of Hospital Non-Compliant A.20Does the denial form include DOH contact information?96 A.22Does the hospital only apply an asset test to patients who are below 150% FPL and only if they have received explicit permission from the NYSDOH to do so? 90 A.4-1Does the hospital require as a condition of receiving financial assistance tax returns as part of its application process? 54 A.4-2Does the hospital require as a condition of receiving financial assistance Medicaid denials as part of its application process? 54 A.8Has the hospital developed a method to measure compliance with HFAL policies and procedures? 51

37. Healthcare Association of New York Statewww.hanys.org

38. Healthcare Association of New York Statewww.hanys.org Indigent Care Pool Methodology  Current Methodology Established beginning with 2013 Indigent Care Pool through a provision in the 2012-13 state budget; Moved from Bad Debt and Charity care methodology; Collapsed the 9 sub-pools for voluntary hospitals into one pool and maintained the public hospital pool; Established a transition methodology; Required substantial compliance with hospital financial assistance law to receive full distribution; and Increased the Voluntary Supplemental Inpatient UPL payments up to $339M.  Current methodology sunsets on December 31, 2015.  New distribution methodology is being negotiated as part of the 2015-16 state budget. 38

39. Healthcare Association of New York Statewww.hanys.org Indigent Care Pool Methodology  Uncompensated care Uninsured units x Medicaid rate for each Inpatient and Outpatient service; Adjusted by statewide cost adjustment factor (Inpatient and Outpatient computed separately); and Reduced by collections received from uninsured patients.  Nominal need Uncompensated care adjusted by a factor which incorporates the Medicaid inpatient percentage.  Allocation Major public hospitals remain at $139.4M; Voluntary hospitals increased by $25M to $994.9M; Proportional allocation in each group is based on the individual hospital’s nominal need to the total nominal need within the group. 39 Source: NYSDOH

40. Healthcare Association of New York Statewww.hanys.org Transition Payment  Provide payments to limit losses by capping the percentage hospitals can gain as compared to current distributions (based on a 3-year average): Year 1 – 2.5% limitation on losses; approx. 10% cap on gains for voluntaries and 2% for major publics; Year 2 – 5.0% limitation on losses; approx. 15% cap on gains for voluntaries and 4% for major publics; and Year 3 – 7.5% limitation on losses; approx. 20% cap on gains for voluntaries and 6% for major publics.  Provide additional $25M (included in $994.9M) for Voluntary Hospital allocations, as part of the Voluntary Hospital UPL payment. 40 Source: NYSDOH

41. Healthcare Association of New York Statewww.hanys.org Governor’s Budget Proposal Maintains overall funding levels and distribution methodology. Maintains but modifies the transition methodology: – Increases the cap on maximum losses by 2.5% per year 10.0% for 2016; 12.5% for 2017; and 15.0% for 2018. DOH must revise methodology if ACA cuts to Medicaid DSH are enacted. – Cuts have been delayed by Congress twice; set to take effect Oct. 1, 2016. Makes permanent the 1% withhold for the “Financial Assistance Compliance Pool.”

42. Healthcare Association of New York Statewww.hanys.org Assembly’s Budget Proposal Accepts the Governor's proposal to extend the current distribution methodology, for three years. Accepts the Governor’s transition maximum loss caps (at same levels) over the three-year extension. Modifies the Governor’s proposal for DOH to revise the methodology if ACA cuts to Medicaid DSH are enacted. – Reconvene the Medicaid Redesign Team (MRT) technical assistance team on indigent care reform by July 1 to develop recommendations related to the distribution methodology and maximum loss caps to target funding to facilities that provide a disproportionate share of care to uninsured, under-insured, and Medicaid populations. Accepts the Governor’s proposal to make permanent the 1% withhold for the “Financial Assistance Compliance Pool.”

43. Healthcare Association of New York Statewww.hanys.org Senate’s Budget Proposal Accepts the Governor's proposal to extend the current distribution methodology, for three years. Accepts the Governor’s transition maximum loss caps (at same levels) over the three-year extension. Does not include the Governor’s contingency provision that would allow DOH to revise the methodology if ACA cuts to Medicaid DSH are enacted. Rejects the Governor’s proposal to make permanent the 1% withhold for the “Financial Assistance Compliance Pool” and instead extends it for 1 year, through calendar year 2016.

44. Healthcare Association of New York Statewww.hanys.org

45. Healthcare Association of New York Statewww.hanys.org DSH Audit State Plan Rate Year 2012 Audit Objectives Assess the State’s compliance with the Medicare Modernization Act of 2003 (MMA) and the DSH Final Rule – The State’s audit protocols to ensure that regulation is satisfied. – If the State made DSH payments to hospitals in excess of their DSH cap. – Compliance with verifications specified in the Final Rule including: DSH payments comply with hospital specific DSH limits; Only uncompensated care costs are used to calculated hospital specific DSH limits; State has record of all Medicaid payments, expenditures and uninsured costs; and State’s definition of costs for individuals that are either Medicaid- eligible or with no source of third-party coverage complies with federal requirements.

46. Healthcare Association of New York Statewww.hanys.org CMS Final Rule Definition of Uninsured (Highlights) December 5, 2014 CMS issued a Final Rule to be effective starting December 31, 2014 (DSH audit 2011). Definition is now applied on a service-specific basis to those services that the individual had no health insurance or other source of third party coverage. – This population needs to be included in the uninsured population for Uncompensated Care Costs Clarified that exhaustion of Medicaid benefits with no other source of third party coverage for the specific service can be included in the Medicaid shortfall. Patients with third-party insurance with high copays/deductibles are still considered insured.

47. Healthcare Association of New York Statewww.hanys.org 2012 DSH Audit Timeline 2012 DSH Audit Webinar 1/22/15 2012 Audit Notification Packages 3/9/15 Hospital Access to KPMG DSH Tool 3/30/15 Deadline for Tool Completion 4/30/15 Audit Fieldwork /Desk Procedures June to August Audit Report to DOH 9/30/15 Audit Report to CMS 12/31/15 Source: KPMG LLP, 2012 DSH Audit Webinar

48. Healthcare Association of New York Statewww.hanys.org 2011 DSH Audit Results Top three findings: 1)Non-allowable charges and payments (57 hospitals) – Hospitals included charges and payments for Part B physician professional services. 2)Denied charges and withheld claims (46 hospitals) – Hospital is unable to identify whether administratively denied services payments and costs for Medicaid-eligible individuals are included in the Tool amounts. 3)Insufficient supporting documentation or audit participation (41 hospitals) – Patient level detail did not reconcile with amounts used in tool. Source: KPMG LLP, 2012 DSH Audit Webinar

49. Healthcare Association of New York Statewww.hanys.org More Information 2012 DSH Audit Webinar Presentation January 22, 2015, slides and recording on HANYS.org Contacts: – DOH Ann Foster (ann.foster@health.ny.gov), Maureen Flanagan (maureen.flanagan@health.ny.gov) – KPMG May Boucherak, Director (mboucherak@kpmg.com), Anthony Trapasso, Manager (atrapasso@kpmg.com

50. Healthcare Association of New York Statewww.hanys.org Contact Information Bob McLeod Vice President, Health Information Healthcare Association of New York State Bmcleod@hanys.orgBmcleod@hanys.org or (518) 431-7908