Add-on (supplemental or ‘kick’) payments are payments to hospitals to augment the fees paid per service by managed care organizations.
These payments affect the claims for service accessed by approximately 7,300 of the 2.8 million recipients in our file. These payments affect claims for inpatient care, including labor and delivery.
Claims are in the CCIP data sets in the costs category. Add-on payments are included as a separate data point. Both are included in Total Costs.
Disproportionate Share payments to Hospitals (DSH payments) are intended to provide additional revenue to the hospitals that routinely treat a greater-than-average number of Medicaid patients. These hospitals receive set sums of money from Healthcare and Family Services (HFS), calculated based on the cost of care for Medicaid and charity care patients. Managed Care Organizations (MCOs) and other healthcare organizations do not receive DSH payments.
DSH payments are included in the net liability of the specific claims to which they were added.
What does ‘Total Costs’ represent?
The Total Costs column totals all the preceding categories that include the word ‘cost.’ This includes add-on payments, Disproportionate Share to Hospitals (DSH) payments, and all other payments for services. It includes capitation payments to Managed Care Organizations (MCOs), Federally Qualified Health Centers (FQHCs), Primary Care Case Management (PCCM), or any other organization paid via capitation.