Pennsylvania Statutes Title 62 P.S. Poor Persons and Public Welfare § 801-E. Definitions

The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

“Assessment.” The fee authorized to be implemented under this article.

“Bad debt expense.”The cost of care for which a hospital expected payment from the patient or a third-party payor, but which the hospital subsequently determines to be uncollectible, as further described in the Medicare Provider Reimbursement Manual published by the United States Department of Health and Human Services.

“Charity care expense.”The cost of care for which a hospital ordinarily charges a fee but which is provided free or at a reduced rate to patients who cannot afford to pay but who are not eligible for public programs, and from whom the hospital did not expect payment in accordance with the hospital's charity care policy, as further described in the Medicare Provider Reimbursement Manual published by the United States Department of Health and Human Services.

“Contractual allowance.”The difference between what a hospital charges for services and the amounts that certain payers have agreed to pay for the services as further described in the Medicare Provider Reimbursement Manual published by the United States Department of Health and Human Services.

“General acute care hospital.”A hospital other than a hospital that the secretary has determined meets one of the following:

(1) Is excluded under 42 CFR 412.23(a), (b), (d), (e) and (f) (relating to Excluded hospitals: Classifications) as of March 20, 2008, from reimbursement of certain Federal funds under the prospective payment system described by 42 CFR 412 (relating to prospective payment systems for inpatient hospital services).

(2) Is a Federal veterans' affairs hospital.

(3) Is a high volume Medicaid hospital.

(4) Provides care, including inpatient hospital services, to all patients free of charge.

(5) Is a free-standing acute care hospital organized primarily for the treatment of and research on cancer and which is an exempt hospital under section 801-G.  1

“High volume Medicaid hospital.”A hospital that the secretary has determined meets all of the following:

(1) is a nonprofit hospital subsidiary of a State-related institution as that term is defined in 62 Pa.C.S. § 103 (relating to definitions); and

(2) has provided more than 60,000 inpatient acute care days of care to Pennsylvania medical assistance patients as reported by the hospital's State fiscal year 2014-2015 medical assistance hospital cost report on file with the department as of June 6, 2018.

“Hospital.” A facility or the site of a facility that is licensed as a hospital under 28 Pa. Code Pt. IV Subpt. B 2 (relating to general and special hospitals) and located within a municipality.

“Municipality.” A city of the first class.

“Net patient revenue.”Gross revenues received or earned by a hospital for inpatient and outpatient hospital services, including medical assistance supplemental revenues received by the hospital for inpatient and outpatient hospital services, less any deducted amounts for bad debt expense, charity care expense and contractual allowances as identified in the hospital's records or on forms as specified by the department.

“Program.” The Commonwealth's medical assistance program as authorized under Article IV.  3