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Public Notice of Final Action for FFY 2024 DSH Payments and Updated Swing Bed Hospital and Administrative Day Rates Effective Oct. 1, 2023

The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following actions regarding its methods and standards for establishing Medicaid Disproportionate Share Hospital (DSH) payments to qualifying DSH hospitals and updating swing bed hospital and administrative day rates.

Pending new federal legislation, implementation of the DSH Patient Protection and Affordable Care Act (ACA) reductions will begin with fiscal year (FY) 2024 and end with FY 2027. The DSH reductions will amount to $8 billion federal dollars each year over a four-year period.

DSH Changes Effective for the Oct. 1, 2023, through Sept. 30, 2024, Payment Period

  • The agency will use the FY ending 2022 base year cost reporting period to calculate the interim DSH payments for the Oct. 1, 2023, thru Sept. 30, 2024, DSH payment period. The agency will continue the use of the Dec. 19, 2008, final rule (Federal Register/Vol. 73, No. 245) relating to the audits of the Medicaid DSH payment plans and the Dec. 3, 2014, final rule (Federal Register/Vol. 79, No. 232) relating to the Medicaid program DSH payments uninsured definition.
  • The agency will update the inflation rate used to trend the DSH base year cost to the end of the 2022 calendar year.
  • The Centers for Medicare and Medicaid Services (CMS) has approved the state directed payment for Health Access, Workforce and Quality (HAWQ) program. As a result of this approval, the agency does not anticipate expending 100% of its federal fiscal year (FFY) 2024 Medicaid DSH allotment to qualifying DSH-eligible hospitals during the Medicaid State Plan rate year.

Inpatient Hospital Reimbursement Changes Effective Oct. 1, 2023

  • The agency will update the inpatient hospital swing bed and administrative day rates based upon the Oct. 1, 2023, redetermination of nursing facility payment rates.

For DSH changes, SCDHHS will implement bullets one through three to calculate the FFY 2024 DSH payments based on the use of the most recent cost reporting period data available (hospital fiscal year 2022) and updated DSH allotment amounts.

For inpatient hospital changes, SCDHHS will update the swing bed and administrative day rates effective Oct. 1, 2023, based upon the redetermination of nursing facility payment rates effective Oct. 1, 2023.

As a result of the actions listed above, the annual projected cost increases are as follows (in total dollars) – DSH – unable to project since FFY 2024 DSH allotments have not been published by CMS as of the date of this notice; swing bed/administrative day rates – immaterial, less than $10,000.

Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at for public review. Additional information concerning the actions above are available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at SCDHHS, Division of Acute Care/Ancillary Reimbursements, Room 400-52, 1801 Main Street, Columbia, S.C., Monday through Friday between 9 a.m. and 5 p.m.

Robert M. Kerr


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Notice of Non-Discrimination

The South Carolina Department of Health and Human Services (SCDHHS) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SCDHHS does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

SCDHHS provides free aids and services to people with disabilities, such as qualified sign language interpreters and written information in other formats (large print, braille, audio, accessible electronic formats, other formats). We provide free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, please contact the Americans with Disabilities Act (ADA)/Civil Rights Official by mail at: PO Box 8206, Columbia, SC 29202-8206, by phone at: 1-888-549-0820 (TTY: 1-888-842-3620), or by email at:

If you believe SCDHHS has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the Civil Rights Official using the contact information provided above. You can file a grievance in person, by mail, or via email. If you need help filing a grievance, we are available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone at: 800-368- 1019, 800-537-7697 (TDD). Complaint forms are available at

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