Labor & Delivery Days
Medicare policy regarding the counting of labor and delivery days in a hospital's disproportionate share (DSH) Medicaid percentage (42 C.F.R. §412.106(b)(4)) is reflected in Section 2205.2 of the PRM. A day for which a Medicaid patient is in the labor and delivery area at the census taking hour is excluded from the count of DSH Medicaid days unless the patient has occupied an inpatient routine bed at some time since admission.
In the August 1, 2003 Federal Register, the Centers for Medicare & Medicaid Services (CMS) clarified its policy for counting labor and delivery days and available beds with respect to hospitals that maintain a single multipurpose labor, delivery, and postpartum (LDP) room. CMS is clarifying that these hospitals may apportion both the days and available beds associated with LDP rooms between the ancillary labor and delivery and the routine adults and pediatrics cost centers. The apportionment is based upon the proportion of the patient's stay in the LDP room that the patient received ancillary services (labor and delivery) as opposed to routine services (postpartum).
Hospitals that maintain an LDP room may apportion the days and available beds associated with the room between the ancillary and routine area based on patient records. In order to ease the administrative burden, CMS is permitting these hospitals to base the apportionment on an average percentage of time all patients receive ancillary services as opposed to routine services in the LDP room during a typical month. WPS will accept an average percentage from a typical month of the hospital's choosing provided the patient records on which the percentage is based are contemporaneous with the cost reporting period under review. We may also ask the hospital to document the month is in fact typical.
For the purpose of apportioning the stay between the ancillary and routine area, we will consider any services furnished after the birth of the baby routine. Consequently, only the time or average percentage of time the patient(s) spent in the LDP room after the birth will be used to apportion days to the routine area and increase the count of available bed days. If the patient first occupied a routine bed and then transferred to the LDP room, all the time spent in the LDP room will be used to apportion days to the routine area and increase the count of available bed days.
The days for Medicaid eligible patients in the LDP room that are apportioned to the routine area are properly added to the numerator of the DSH percentage. In addition, the days for all patients in the LDP room that are apportioned to the routine area must be added to the denominator of the DSH percentage.