§ 44–665.01. Definitions.

For the purposes of this subchapter, the term:

(1) "Department" means the Department of Health Care Finance.

(2) "District retention" means an amount equal to 13.125% of the fees collected under § 44-665.03(a)(1), plus the salary and fringe benefits for one full-time equivalent staff position at the Department.

(3) "Fund" means the Inpatient Hospital Directed Payment Provider Fee Fund established by this subchapter.

(4) "Hospital" shall have the same meaning as provided in § 44-501(a)(9); except, that the term "hospital" shall not include any specialty hospital, as defined by the District of Columbia's Medicaid State Plan, a hospital that is reimbursed under a specialty hospital reimbursement methodology under the State Plan, or a hospital operated by the federal government.

(5) "Hospital system" means a group of hospitals licensed separately but operated, owned, or maintained by a common entity.

(6) "Medicaid" means the medical assistance programs authorized by Title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), and by § 1-307.02, and administered by the Department.

(7)(A) "Inpatient net patient revenue" means the result of the following calculation:

(i) The quotient of the number appearing in Column 1 of Line 28 on Worksheet G-2 of the hospital's most recently available filed Hospital and Hospital Health Care Complex Cost Report ("Form CMS-2552-10");

(ii) Divided by the number appearing in Column 3 of Line 28 on Worksheet G-2 of that report; and

(iii) Multiplied by the number appearing in Column 1 of Line 3 of Worksheet G-3 of that report.

(B) Notwithstanding subparagraph (A) of this paragraph, for a hospital that has not yet filed its first Form CMS-2552-10, the term "inpatient net patient revenue" shall mean a dollar value determined by the Department, based on projected utilization volume and projected utilization migration from other area hospitals, that approximates the hospital's expected inpatient net patient revenue.

(8) "State directed payment" means a Medicaid managed care delivery system and provider payment initiative authorized under 42 C.F.R. § 438.6(c).