§346G-10  Private hospital payments through enhanced payments to medicaid managed care health plans.  (a)  The department shall use moneys from the hospital sustainability program special fund solely to fulfill the requirements of section 346G-4(c).

     (b)  In accordance with title 42 Code of Federal Regulations part 438, the department shall use revenues from the hospital sustainability fee and federal matching funds to enhance payments to medicaid managed care health plans, consistent with the following objectives:

     (1)  The enhanced payments shall be used exclusively to increase reimbursements to private hospitals, support the availability of services, and ensure access to care for medicaid managed care health plan enrollees;

     (2)  The enhanced payments shall be paid by the department to medicaid managed care health plans, which shall provide documentation to the department and the hospital trade association located in the State certifying that the revenues received under paragraph (1) are used in accordance with this section;

     (3)  The enhanced payment rates shall be actuarially sound and approved by the federal government for federal fund participation;

     (4)  The enhanced payment rates shall be retroactive to July 1, 2012, or the effective date approved by the federal government, whichever is later.  Retroactive enhanced payment rates shall be paid within thirty days of notification by the Centers for Medicare and Medicaid Services to the department of all necessary approvals;

     (5)  Payments made by the medicaid managed care health plans shall be made within thirty business days upon receipt of payment from the department; and

     (6)  Each managed care health plan shall expend one hundred per cent of any increased payments received under this section to carry out the goals of the hospital sustainability program.

     (c)  If federal approval pursuant to section 346G-7 is not received until after the end of any month for which the hospital sustainability fee is applicable, the department shall make the initial monthly payments within five days after receipt of the hospital sustainability fee for the respective month.

     (d)  To the extent the hospital sustainability program is not effective for the entire year, the hospital sustainability fee, the state medicaid expenses and administrative fee, and the corresponding payments to fulfill the requirements of section 346G-4(c) shall be based on the proportion of the fiscal year the program is in effect. [L 2012, c 217, pt of §2, §5; am L 2013, c 141, pt of §1, §2; am L 2014, c 123, §§1(3), (4), 2; am L 2015, c 70, §§1(5), 2; am L 2016, c 60, §§2(5), 3; am L 2017, c 59, §§4, 5; am L 2018, c 18, §22; am L 2019, c 173, §§4, 6; am L 2021, c 38, §§5, 7; am L 2023, c 110, §§9, 11]