Section 5701.1104 - Eligibility and payment(a) Determination of eligibility.--The department shall determine the eligibility of each hospital from information collected under section 1103 . (b) Requirements for hospitals.--A hospital is eligible to apply for payment from the Hospital Uncompensated Care Program if the hospital has a plan in place to serve the uninsured and:(1) Accepts all individuals regardless of the ability to pay for emergent medically necessary services within the scope of the hospital's service.(2) Seeks collection of a claim, including collection from an insurer or payment arrangements with the person who is responsible for payment of the care rendered.(3) Attempts to obtain health care coverage for patients, including assisting patients in applying for medical assistance, the Children's Health Insurance Program or the Adult Basic Coverage Insurance Program established in section 1303(a) , when applicable.(4) Ensures that an emergency admission or treatment is not delayed or denied pending determination of coverage or requirement for prepayment or deposit.(5) Posts adequate notice of the availability of medical services and the obligations of hospitals to provide free services.(6) Provides data to the council in accordance with section 1103.(c) Uncompensated care scoring.--The department shall annually calculate the uncompensated care score of each eligible hospital from collected data. If information necessary to determine the uncompensated care score of an eligible hospital is unavailable due to the refusal of the hospital to provide the information, the hospital shall not be eligible for payment from the Hospital Uncompensated Care Program. If the department determines that such data cannot be provided after due diligence, the department shall use the average of the collected data. An eligible hospital's uncompensated care score shall be the sum of the following, using three-year average data as determined by the department: (1) The amount of uncompensated care provided as a percentage of net patient revenue based on the most recent hospital financial analysis data reported to the council in accordance with the act of July 8, 1986 (P.L. 408, No. 89) , known as the Health Care Cost Containment Act.(2) The number of Medicare SSI days as a percentage of total inpatient days based on the most recent data available to the department.(3) The number of medical assistance days as a percentage of total inpatient days based on the most recent data available to the department.(d) Payment calculation.--A payment to a qualified hospital shall be calculated as follows:(1) Multiplying each qualified hospital's uncompensated care score by the three-year average of its total reported inpatient days.(2) Dividing the product under paragraph (1) for each qualified hospital by the sum of the products under paragraph (1) for all qualified hospitals.(3) Multiplying the quotient under paragraph (2) by the moneys available for the Hospital Uncompensated Care Program.(e) Limitations.-- Except as stated in section 1106: (1) In no case shall the sum of payments to a qualified hospital under this section and payments under the medical assistance program exceed the aggregate cost of the inpatient and outpatient services furnished to: (i) recipients entitled to medical benefits under Title XIX of the Social Security Act (49 Stat. 620, 42 U.S.C.§ 1396 et seq.);(ii) recipients entitled to medical benefits under section 441.1 of the act of June 13, 1967 (P.L. 31, No. 21), known as the Public Welfare Code; and(iii) patients receiving uncompensated care.(2) In no case shall payments made under this section in a fiscal year exceed the amount of money available to the department for the Hospital Uncompensated Care Program for that fiscal year.(3) In no case shall payment under this section constitute an entitlement derived from the Commonwealth or a claim on any other funds of the Commonwealth.(4) In no case shall payment under this section to a qualified hospital exceed the hospital's annual uncompensated care amount as provided in the council's most recently published hospital financial report.(f) Three-year average.--For purposes of this section, for fiscal years up to and including 2002-2003, the term "three-year average" shall be determined by the department. For fiscal years 2003-2004 and thereafter, the term "three-year average" shall be the average of the immediately preceding three years.(g) Mergers and separations.--The department shall combine payments for hospitals which have merged into a single entity. The department shall fairly allocate payments for a hospital which separated into two or more entities, as appropriate.2001, June 26, P.L. 755, No. 77, § 1104, effective 7/1/2001.