| (9) Participation in all voluntary Medicaid programs.
Beginning in Federal Fiscal Year (FFY) 2024, it will be required for
all non-rural hospitals, except for state-owned hospitals, to enroll,
participate in, and comply with requirements for all voluntary supplemental
Medicaid or directed Medicaid programs for which the hospital is eligible,
including all components of those programs, within the State of Texas
to participate in DSH, unless:
(A) a hospital is not required to enroll, participate
in, and comply with the requirements:
(i) of a program without multiple components if the
hospital's estimated payment from the entire program is less than
$25,000; or
(ii) of a program's component for programs that have
multiple components if the hospital's estimated payment from the program's
component is less than $25,000; and
(B) enrollment for the program concluded after the
effective date of this requirement.
(f) State payment cap and hospital-specific limit calculation.
HHSC uses the methodology described in §355.8066 of this title
to calculate a state payment cap for each Medicaid hospital that applies
and qualifies to receive payments for the DSH program year under this
section, and a hospital-specific limit for each hospital that received
payments in a prior program year under this section. For payments
for each DSH program year beginning before October 1, 2017, the state
payment cap calculated as described in §355.8066 will be reduced
by the amount of prior payments received by each participating hospital
for that DSH program year. These prior payments will not be considered
anywhere else in the calculation.
(g) Distribution of available DSH funds. HHSC will
distribute the available DSH funds as defined in subsection (b)(2)
of this section among eligible, qualifying DSH hospitals using the
following priorities.
(1) State-owned hospitals. HHSC may reimburse state-owned
teaching hospitals, state-owned IMDs, and public health hospitals
an amount less than or equal to its state payment caps, except that
aggregate payments to IMDs statewide may not exceed federally mandated
reimbursement limits for IMDs.
(2) Rural public hospitals. HHSC will set aside an
amount for rural public hospitals. While the funds are set aside before
the non-state hospital funding, the payments will be calculated for
each hospital after the non-state hospital payments are calculated.
(3) Rural private hospitals. If funds remain from the
amount set aside in subsection (g)(2) of this section for rural public
hospitals after paying all hospitals up to their state payment caps,
HHSC may set aside a portion of the remaining funds for rural private
hospitals.
(4) Non-state hospitals. HHSC distributes the remaining
available DSH funds, if any, to other qualifying hospitals using the
methodology described in subsection (h) of this section, including
rural public and rural private hospitals.
(A) The remaining available DSH funds equal the lesser
of the funds as defined in subsection (b)(2) of this section less
funds expended under paragraph (1), (2), and (3) of this subsection
or the sum of remaining qualifying hospitals' state payment caps.
(B) The remaining available general revenue funds equal
the funds as defined in subsection (b)(3) of this section.
(h) DSH payment calculation.
(1) Data verification. HHSC uses the methodology described
in §355.8066(e) of this title to verify the data used for the
DSH payment calculations described in this subsection. The verification
process includes:
(A) data sources for the application will include but
not limited to Tax Assessor Receipts/Invoices or other official documentation
of tax revenue/statements, Medicare Cost Report, and third-party data
sources;
(B) notice to hospitals of the data provided to HHSC
by Medicaid contractors; and
(C) an opportunity for hospitals to request HHSC review
of disputed data.
(2) Establishment of DSH funding pools for non-state
hospitals. From the amount of remaining DSH funds determined in subsection
(g)(3) of this section, HHSC will establish three DSH funding pools.
(A) Pool One.
(i) Pool One is equal to the sum of the remaining available
general revenue funds and associated federal matching funds.
(ii) Pool One payments are available to all non-state-owned
hospitals, including non-state-owned public hospitals.
(B) Pool Two.
(i) Pool Two is equal to the lesser of:
(I) the amount of remaining DSH funds determined in
subsection (g)(3) of this section less the amount determined in paragraph
(2)(A) of this subsection multiplied by the FMAP in effect for the
program year; or
(II) the federal matching funds associated with the
intergovernmental transfers received by HHSC that make up the funds
for Pool Three; and
(ii) Pool Two payments are available to all non-state-owned
hospitals except for any transferring public hospitals as defined
in subsection (b) of this section; or non-urban public hospital as
defined in subsection (b) of this section that does not transfer any
funds to HHSC for Pool Three as described in subparagraph (C)(iii)
of this paragraph.
(C) Pool Three.
(i) Pool Three is equal to the sum of intergovernmental
transfers for DSH payments received by HHSC from governmental entities
that own and operate transferring public hospitals and non-urban public
hospitals.
(ii) Pool Three payments are available to the hospitals
that are operated by or under lease contracts with the governmental
entities described in clause (i) of this subparagraph that provide
intergovernmental transfers.
(iii) HHSC will allocate responsibility for funding
Pool Three as follows.
(I) Non-urban public hospitals. Each governmental entity
that operates or is under a lease contract with a non-urban public
hospital is responsible for funding the non-federal share of the hospital's
DSH payments from Pool Two (calculated as described in paragraphs
(3) and (4) of this subsection) to that hospital.
(II) Transferring public hospitals. Each governmental
entity that owns and operates a transferring public hospital is responsible
for funding the non-federal share of the DSH payments from Pool Two
(calculated as described in paragraphs (3) and (4) of this subsection)
to its affiliated hospital and a portion of the non-federal share
of the DSH payments from Pool Two to private hospitals. For funding
payments to private hospitals, HHSC will initially suggest an amount
in proportion to each transferring public hospitals' individual state
payment cap relative to total state payment caps for all transferring
public hospitals. If an entity transfers less than the suggested amount,
HHSC will take the steps described in paragraph (4)(H) of this subsection.
(III) Following the calculations described in paragraph
(5) of this subsection, HHSC will notify each governmental entity
of its allocated intergovernmental transfer amount.
(3) Distribution and payment calculation for Pools
One and Two initial payment, Standard DSH payment.
(A) HHSC will first determine the state payment cap
for the hospital in accordance with §355.8066 of this division,
including any year-to-date uncompensated-care (UC) payments as defined
in §355.8212 of this subchapter (relating to Waiver Payments
to Hospitals for Uncompensated Charity Care) attributable to the state
payment cap.
(B) All hospitals that meet DSH qualification and eligibility
criteria will be allocated an initial payment from Pools One and Two.
Initial payments will be allocated as follows.
(i) A hospital will receive a payment that is the greater
of:
(I) the hospital's Medicaid shortfall; or
(II) a standard DSH payment.
(ii) If the amount calculated in clause (i) of this
subparagraph is greater than the hospital's state payment cap after
considering the state share required to fund the standard DSH payment,
the hospital will receive their state payment cap.
(C) HHSC will determine the standard DSH payment amount
described in subparagraph (B)(i)(II) of this paragraph annually in
an amount not to exceed $10,000,000 per hospital for hospitals that
have reported residents on their Medicare cost report or in an amount
not to exceed $10,000,000 per hospital for hospitals that have not
reported residents on their Medicare cost report.
(D) For a privately-owned institution of mental disease
their minimum payment amount may be reduced to ensure that payments
for all IMDs remain below the IMD cap.
(4) Distribution and payment calculation for Pools
One and Two secondary payment, percentage of costs covered.
(A) The costs considered for the percentage of costs
covered will be the costs included in the state payment cap in paragraph
(3)(A) of this subsection.
Cont'd... |
