DSH FY 12-13 LIUR Formula 11-20-2012
DSH FY 12-13 LIUR Formula 11-20-2012
DSH FY 12-13 LIUR Formula 11-20-2012
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Total Other<br />
Inpatient<br />
Charity<br />
=<br />
County Indigent<br />
Program Gross<br />
Inpatient Revenue<br />
(L<strong>12</strong>41509)<br />
+<br />
County Indigent Program<br />
Managed Care Gross<br />
Inpatient Revenue<br />
(L<strong>12</strong>415<strong>11</strong>)<br />
―<br />
County Indigent<br />
Program Gross<br />
Inpatient Charity<br />
(L<strong>12</strong>43009)<br />
―<br />
Inpatient County<br />
Indigent Program<br />
Managed Care<br />
Patient Charity<br />
(L<strong>12</strong>430<strong>11</strong> x B)<br />
+<br />
Gross<br />
Inpatient<br />
Charity<br />
―<br />
Gross Inpatient<br />
Charity<br />
Gross Patient<br />
Charity<br />
(L<strong>12</strong>43023)<br />
*<br />
Hill-Burton Gross<br />
Patient Charity<br />
(L0835001)<br />
+<br />
UC Gross Inpatient<br />
Teaching Allowances<br />
(L<strong>12</strong>44017)<br />
+<br />
UC Gross Inpatient<br />
Absolute Clinical Teaching<br />
Value Support<br />
(L<strong>12</strong>44517)<br />
Where,<br />
Gross<br />
Inpatient<br />
Charity<br />
=<br />
Non-Medi-Cal Gross Inpatient<br />
Charity<br />
(L<strong>12</strong>43001 + L<strong>12</strong>43009 +<br />
L<strong>12</strong>430<strong>13</strong> + L<strong>12</strong>43019)<br />
+<br />
Inpatient Non-Medi-Cal Managed<br />
Care Gross Inpatient Charity<br />
(L<strong>12</strong>43003 x A*<br />
+ L<strong>12</strong>430<strong>11</strong> x B*<br />
+ L<strong>12</strong>43015 x C*)<br />
+<br />
Other Indigent<br />
Gross Inpatient<br />
Charity<br />
(L<strong>12</strong>43017)<br />
+<br />
Medi-Cal Gross<br />
Inpatient Revenue<br />
(L<strong>12</strong>41505)<br />
Medi-Cal Gross<br />
Patient Revenue<br />
(L<strong>12</strong>41505 +L<strong>12</strong>41506)<br />
*<br />
Medi-Cal Gross<br />
Patient Charity<br />
(L<strong>12</strong>43005)<br />
+<br />
Inpatient Medi-Cal Managed Care<br />
Gross Patient Charity<br />
(L<strong>12</strong>43007 x D*)<br />
Page 4 of 5<br />
Safety Net Financing Division<br />
<strong>DSH</strong> Unit<br />
Revised on November <strong>20</strong>, <strong>20</strong><strong>12</strong>
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