§346G-5  Hospital sustainability fee.  [See Note at chapter heading.]  (a)  Effective July 1, 2012, or, if later, the effective date of any necessary federal approvals, the department shall charge and collect  provider fees, to be known as the hospital sustainability fee, on inpatient and outpatient care services provided by private hospitals.

     (b)  The hospital sustainability fee shall be based on the net patient service revenue for inpatient services and outpatient services, respectively, of all hospitals that are subject to the hospital sustainability fee.

     (c)  The hospital sustainability fee for inpatient care services may differ from the fee for outpatient care services but the fees charged to the hospital shall not in the aggregate exceed three and one-half per cent of the hospital's net patient service revenue.  The inpatient hospital sustainability fee shall not exceed three and one-half per cent of net inpatient hospital service revenue.  The outpatient hospital sustainability fee shall not exceed three and one-half per cent of net outpatient hospital service revenue.  Each fee shall be the same percentage for all affected hospitals, subject to subsection (d).

     (d)  The department shall exempt children's hospitals, federal hospitals, public hospitals, and psychiatric hospitals from the hospital sustainability fees on inpatient services.  In addition, the department shall exempt from the hospital sustainability fee on outpatient care services children's hospitals, public hospitals, rehabilitation hospitals, psychiatric hospitals, and any hospitals with net outpatient revenues of less than $57,000,000 per year based upon the hospital's medicare cost report for the fiscal year ending three years prior to the state fiscal year for which the hospital's net patient service revenue is calculated; provided that the department may exclude any facility from the hospital sustainability fee on outpatient care services if it is determined that its exclusion is required to meet federal standards of approval.

     (e)  The department, with agreement by the hospital trade association located in Hawaii, may modify the structure of the hospital sustainability program if such modification is necessary to obtain federal waiver approval consistent with the requirements of 42 Code of Federal Regulations section 433.68(e)(2).

     (f)  Notwithstanding section 346G-6, nothing shall require the department to exempt a facility from the hospital sustainability fee if it is not approved by the United States Department of Health and Human Services Centers for Medicare and Medicaid Services. [L 2012, c 217, pt of §2, §5; am L 2013, c 141, pt of §1, §2; am L 2014, c 123, §§1(2), 2; am L 2015, c 70, §§1(3), 2; am L 2016, c 60, §§2(3), 3; am L 2017, c 59, §§3, 5]