DSH FY 12-13 LIUR Formula 11-20-2012

Medicaid 2
Fraction
= 100 *
Medicaid Fraction 1
Medi-Cal Paid
Patient Revenue
+
Total Cash Subsidies from
State and Local Governments
Total Paid Patient Revenue
Where,
Medi-Cal
Paid
Patient
Revenue
=
Medi-Cal Net
Patient Revenue
(L1246005)
―
QAF Fee-for-
Service Payments
–Selected Privates 3 +
Medi-Cal
Short-Doyle
Net Patient
Revenue 4
Disproportionate
― Absolute Share Payments
Value (L1242605 or
L1242613)
+
Medi-Cal Managed
Care Net
Patient Revenue
(L1246007)
―
QAF Managed
Care Payments –
Selected Privates 3
Total Cash Subsidies
from State and
Local Governments
=
Absolute UC Gross Clinical
Value Teaching Support
(L1244523)
+
County Indigent Program
Net Patient Revenue
(L1246009 + L1246010)
+
County Indigent Program
Managed Care
Net Patient Revenue
(L1246011)
Total Paid
Patient Revenue
=
Total Net
Patient Revenue
(L0811001)
―
QAF Fee-for-Service
Payments – Selected
Privates 3
―
QAF Managed Care
Payments – Selected
Privates 3
―
Disproportionate
Absolute Share Payments
Value (L1242605 or
L1242613)
1. Unless otherwise noted, all data are derived from the OSHPD Annual Financial Disclosure Report (AFDR) for the hospital’s fiscal year ending (FYE)
in 2010.
2. 0 ≤ Medicaid Fraction ≤ 100.
3. Pursuant to the OSHPD Technical Letter, private hospitals with FYE in Dec. were required to report the Quality Assurance Fee (QAF) Program
payments in the CY 2010 AFDR. As such, the QAF payments made to private hospitals with FYE in Dec. will be accounted for in the FY 2012-13
LIUR calculation.
4. Medi-Cal Short-Doyle paid claims for calendar year of service 2010 with dates of payment through February 2012.
Page 2 of 5
Safety Net Financing Division
DSH Unit
Revised on November 20, 2012