EXAMPLES

Hospital A is an urban hospital with 200 beds and has a DSH percentage of 21 percent. Its December 1990 DSH payment factor is computed:

(21 - 20.2) (.65) + 5.62 = 6.14% 

DSH adjustment factor = 6.14% (.0614)

Hospital B is an urban hospital with 250 beds and has a DSH percentage of 45 percent. Its December 1990 DSH payment adjustment factor is computed:

(45 - 20.2) (.65) + 5.62% = 21.74% 

DSH adjustment factor = 21.74% (.2174)

Urban hospitals with 100 or more beds and rural hospitals with 500 or more beds whose DSH percentage is equal to or less than 20.2 - the following formula is used:

(DSH % - 15) (.6) + 2.5

• Urban hospitals with fewer than 100 beds - 5 percent. 

• Rural hospitals that are RRCs and sole community hospitals - the greater of 10 percent or the percentage determined using the following formula:

(DSH % - 30) (.6) + 4.0

Hospital C is a rural hospital that is an RRC and a sole community hospital, and has a DSH percentage of 35 percent. Its DSH payment factor is computed:

(35 - 30) (.6) + 4.0 = 7%

DSH adjustment factor = 10% (.1000)

Hospital D is a rural hospital which is a RRC and a sole community hospital. It has a DSH percentage of 45 percent. Its DSH payment factor is computed:

(45 - 30) (.6) + 4.0 = 13%

DSH adjustment factor is 13% (.1300)

• Rural hospitals that are RRCs, but are not sole community hospitals-the following formula is used:

(DSH % - 30) (.6) + 4.0

• Rural hospitals that are sole community hospitals, but are not RRCs - 10 percent.

• Rural hospitals not described above with 100 beds or less - 4 percent if DSH percentage is 45 percent or more.

• Rural hospitals not described above with more than 100 beds but fewer than 500 beds - 4 percent if DSH percentage is 30 percent or more.

• Urban hospitals with 100 or more beds whose DSH percentage is less than or equal to 20.2 - the following formula is used:

(DSH % - 15) (.6) + 2.5

For the period October 1, 1993, through September 30, 1994:

• Urban hospitals with 100 or more beds whose DSH percentage is greater than 20.2-the following formula is used:

(DSH % - 20.2) (.8) + 5.88

• Urban hospitals with 100 or more beds whose DSH percentage is less than or equal to 20.2 - the following formula is used:

(DSH % - 15) (.6) + 2.5

• Rural hospitals that are RRCs and sole community hospitals - the greater of 10 percent or the percentage determined using the following formula: 

(DSH % - 30) (.6) + 4.0