Code of the District of Columbia

Subchapter VIII. Hospital Inpatient Rate Supplement.


§ 44–664.11. Definitions.

For the purposes of this subchapter, the term:

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

(2) "Hospital" shall have the same meaning as provided in § 44-501(a)(1), but excludes any hospital operated by the federal government and any specialty hospital, as defined by the District of Columbia's Medicaid State Plan ("State Plan"), or a hospital that is reimbursed under a specialty hospital reimbursement methodology under the State Plan.

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

(4) "Inpatient net patient revenue" means the amount calculated in accordance with generally accepted accounting principles for hospitals as derived from each hospital's filed Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), filed for the period between October 1 and September 30 of the period 3 fiscal years prior to the fiscal year the fee is assessed, using the references below:

(A) The sum of: Worksheet G-2; Column 1; Lines 1, 2, 3, 4, 16 and 18;

(B) Minus: The ratio of the sum of Worksheet G-2; Column 1; Lines 5, 6, and 7 divided by Worksheet G-2; Column 1; Line 17 multiplied by Worksheet G-2; Column 1; Line 18;

(C) Divided by: Worksheet G-2; Column 3; Line 28; and

(D) Multiplied by: Worksheet G-3; Column 1; Line 3.

(5) "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.) ("Social Security Act"), and by § 1-307.02, and administered by the Department.


(Dec. 13, 2017, D.C. Law 22-33, § 5082, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5042(a), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5083(a), 66 DCR 8621.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5083(a) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5083(a) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5042(a) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5042(a) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5082 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5082 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.12. Hospital Fund.

(a) There is established as a special fund the Hospital Fund ("Fund"), which shall be administered by the Department in accordance with subsection (c) of this section.

(b) Revenue from the following sources shall be deposited in the Fund:

(1) Fees collected under this subchapter;

(2) Interest and penalties collected under this subchapter; and

(3) Other amounts collected under this subchapter.

(c) Money in the Fund shall be used solely as set forth in § 44-664.13(a)(2).

(d)(1) The money deposited in the Fund shall not revert to the unrestricted fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time.

(2) Subject to authorization in an approved budget and financial plan, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation; provided, that any remaining money in the Fund at the end of each fiscal year shall be refunded to hospitals in proportion to the amounts paid by them.


(Dec. 13, 2017, D.C. Law 22-33, § 5083, 64 DCR 7652.)

Emergency Legislation

For temporary (90-day) creation of this section, see § 5083 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5083 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.13. Hospital provider fee.

(a)(1) Beginning October 1, 2020, and except as provided in subsection (b) of this section and section 5087, the District, through the Office of Tax and Revenue, may charge each hospital a fee based on its inpatient net patient revenue.

(2) The fee shall be charged at a uniform rate necessary to generate no more than $8,454,038 to support inpatient Medicaid Fee-for-Service and managed care rates at the District Fiscal Year 2015 level of not less than 98% of cost to non-specialty hospitals.

(3) The fee collected pursuant to this section shall be deposited in the Hospital Fund, established by section 5083.

(b) A psychiatric hospital that is an agency or a unit of the District government is exempt from the fee imposed under subsection (a) of this section, unless the exemption is adjudged to be unconstitutional or otherwise invalid, in which case a psychiatric hospital that is an agency or a unit of the District government shall pay the fee imposed by subsection (a) of this section.

(c) If necessary, by August 1, 2019, the Department shall submit a provider tax waiver application to the Center for Medicare and Medicaid Services to ensure the provisions of this subchapter qualify as a broad-based health care related tax, as that term is defined in section 1903(w)(3)(B) of the Social Security Act.


(Dec. 13, 2017, D.C. Law 22-33, § 5084, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5042(b), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5083(b), 66 DCR 8621; Dec. 3, 2020, D.C. Law 23-149, § 5003, 67 DCR 10493.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5083(b) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5083(b) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5042(1) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5042(1) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5084 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5084 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.14. Quarterly notice and collection.

(a) The fee imposed under § 44-664.13 shall be due and payable by the 15th of the last month of each DFY quarter.

(b) The fee imposed under § 44-664.13 shall be calculated, due, and payable on a quarterly basis, but shall not be due and payable until the District issues written notice to each hospital informing the hospital of its fee rate, inpatient net patient revenue subject to the fee, and the fee amount owed on a quarterly basis, including, in the initial written notice from the District to the hospital, all fee amounts owed beginning with the period October 1 of each District Fiscal Year, to ensure all applicable fee obligations have been identified.

(c)(1) If a hospital fails to pay the full amount of its fee by the date required, the unpaid balance shall accrue interest at the rate of 1.5% per month or any fraction thereof, which shall be added to the unpaid balance.

(2) The Chief Financial Officer may arrange a payment plan for the amount of the fee and interest in arrears.

(d) The payment by the hospital of the fee created in this subchapter shall be reported as an allowable cost for purposes of Medicaid hospital reimbursement.


(Dec. 13, 2017, D.C. Law 22-33, § 5085, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5042(c), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5083(c), 66 DCR 8621.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5083(c) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5083(c) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5042(c) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5042(c) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5085 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5085 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.15. Multi-hospital systems, closure, merger, and new hospitals.

(a) If a hospital system conducts, operates, or maintains more than one hospital licensed by the Department of Health, the hospital system shall pay the fee for each hospital separately.

(b)(1) Notwithstanding § 44-664.13, if a hospital system or person that is subject to a fee under § 44-664.13 ceases to conduct, operate, or maintain a hospital, as evidenced by the transfer or surrender of a hospital license, the fee for the DFY in which the cessation occurs shall be adjusted by multiplying the fee computed under § 44-664.13 by a fraction, the numerator of which is the number of days in the year during which the hospital system or person conducts, operates, or maintains the hospital and the denominator of which is 365.

(2) Immediately upon ceasing to conduct, operate, or maintain a hospital, the hospital system or person shall pay the fee for the year as so adjusted, to the extent not previously paid.

(c) Notwithstanding any other provision of this subchapter, a hospital system or person who conducts, operates, or maintains a hospital, upon notice by the Department, shall pay the fee required under § 44-664.13 in accordance with subsection (a) of this section on the due date stated in the notice and on the regular installment due dates for the DFY occurring after the due date of the initial notice.


(Dec. 13, 2017, D.C. Law 22-33, § 5086, 64 DCR 7652.)

Emergency Legislation

For temporary (90-day) creation of this section, see § 5086 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5086 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.16. Federal determinations; suspension and termination of assessment.

(a) If the Centers for Medicare and Medicaid Services determines that an assessment imposed on a hospital pursuant to this subchapter does not satisfy the requirements for federal financial participation set forth in section 1903(w) of the Social Security Act, that determination shall not affect the validity, amount, applicable rate, or any other terms of an assessment on other hospitals imposed by this subchapter.

(b) If the Centers for Medicare and Medicaid Services determines that an exclusion for specialty hospitals under this subchapter would prevent an assessment imposed by this subchapter from qualifying as a broad-based health care related tax, as that term is defined in section 1903(w)(3)(B) of the Social Security Act, the exclusion of specialty hospitals shall not be made.


(Dec. 13, 2017, D.C. Law 22-33, § 5087, 64 DCR 7652.)

Emergency Legislation

For temporary (90-day) creation of this section, see § 5087 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5087 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.17. Rules.

The Mayor, subchapter I of Chapter 5 of Title 2, may issue rules to implement the provisions of this subchapter.


(Dec. 13, 2017, D.C. Law 22-33, § 5088, 64 DCR 7652.)

Emergency Legislation

For temporary (90-day) creation of this section, see § 5088 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5088 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).


§ 44–664.18. Applicability; sunset.

This subchapter shall expire on September 30, 2029.


(Dec. 13, 2017, D.C. Law 22-33, § 5089, 64 DCR 7652; Oct. 30, 2018, D.C. Law 22-168, § 5042(d), 65 DCR 9388; Sept. 11, 2019, D.C. Law 23-16, § 5083(d), 66 DCR 8621.)

Emergency Legislation

For temporary (90 days) amendment of this section, see § 5083(d) of Fiscal Year 2020 Budget Support Congressional Review Emergency Act of 2019 (D.C. Act 23-112, Sept. 4, 2019, 66 DCR 11964).

For temporary (90 days) amendment of this section, see § 5083(d) of Fiscal Year 2020 Budget Support Emergency Act of 2019 (D.C. Act 23-91, July 22, 2019, 66 DCR 8497).

For temporary (90 days) amendment of this section, see § 5042(d) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).

For temporary (90 days) amendment of this section, see § 5042(d) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).

For temporary (90-day) creation of this section, see § 5089 of the Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017, effective October 24, 2017 (D.C. Act 22-167; 64 DCR 10802).

For temporary (90-day) creation of this section, see § 5089 of the Fiscal Year 2018 Budget Support Emergency Act of 2017, effective July 20, 2017 (D.C. Act 22-104; 64 DCR 7032).