| (B) The payments considered for the percentage of costs
covered will be the payments included in the state payment cap in
paragraph (3)(A) of this subsection plus the standard DSH payment
after considering the state share required to fund the hospital's
payment. Transferring hospitals will not have IGT paid for private
hospitals for the standard DSH payment included in their percentage
of cost covered.
(C) The hospital's percentage of cost covered will
be equal to the payments in subparagraph (B) of this paragraph divided
by the cost in subparagraph (A) of this paragraph.
(D) HHSC will determine an allocation percentage such
that all hospitals receive a uniform percentage of their costs covered
to fully utilize Pools One and Two, Pass Two.
(E) If a hospital's percentage of cost covered is greater
than the allocation percentage, it will not be eligible for a Pool
One and Two secondary payment.
(F) If a hospital's percentage of cost covered is lower
than the allocation percentage, it will be allocated a projected payment
such that its percentage of cost covered is equal to the uniform percentage
in subparagraph (D) of this paragraph.
(G) If a governmental entity that operates or is under
a lease contract with a non-urban public hospital does not fully fund
the amount described in paragraph (2)(C)(iii)(I) of this subsection,
HHSC will reduce that portion of the hospital's Pool Two payment to
the level supported by the amount of the intergovernmental transfer.
(H) If a governmental entity that owns and operates
a transferring public hospital does not fully fund the amount described
in paragraph (2)(C)(iii)(II) of this subsection, HHSC will take the
following steps.
(i) Provide an opportunity for the governmental entities
affiliated with the other transferring public hospitals to transfer
additional funds to HHSC.
(ii) Recalculate total Pool Two payments for transferring
public hospitals and private hospitals based on actual IGT provided
by each transferring public hospital using a methodology determined
by HHSC.
(5) Pass One distribution and payment calculation for
Pool Three.
(A) HHSC will calculate the initial payment from Pool
Three as follows.
(i) For each transferring public hospital:
(I) divide the Pool Two payments from paragraphs (3)
and (4) of this subsection by the FMAP for the program year; and
(II) multiply the result from subclause (I) of this
clause by the non-federal percentage. The result is the Pass One initial
payment from Pool Three for these hospitals.
(ii) For each Non-urban public hospital:
(I) divide the Pool Two payments from paragraphs (3)
and (4) of this subsection by the FMAP for the program year; and
(II) multiply the result from subclause (I) of this
clause by the non-federal percentage. The result is the Pass One initial
payment from Pool Three for these hospitals.
(iii) For all other hospitals, the Pass One initial
payment from Pool Three is equal to zero.
(B) HHSC will calculate the secondary payment from
Pool Three for each transferring public hospital as follows.
(i) Sum the intergovernmental transfers made on behalf
of all transferring public hospitals.
(ii) For each transferring public hospital, divide
the intergovernmental transfer made on behalf of that hospital by
the sum of the intergovernmental transfers made on behalf of all transferring
public hospitals from clause (i) of this subparagraph.
(iii) Sum all Pass One initial payments from Pool Three
from subparagraph (A) of this paragraph.
(iv) Subtract the sum from clause (iii) of this subparagraph
from the total value of Pool Three.
(v) Multiply the result from clause (ii) of this subparagraph
by the result from clause (iv) of this subparagraph for each transferring
public hospital. The result is the Pass One secondary payment from
Pool Three for that hospital.
(vi) For all other hospitals, the Pass One secondary
payment from Pool Three is equal to zero.
(C) HHSC will calculate each hospital's total Pass
One payment from Pool Three by adding its Pass One initial payment
from Pool Three and its Pass One secondary payment from Pool Three.
(6) Pass Two - Secondary redistribution of amounts
in excess of state payment caps for Pool Three. For each hospital
that received a Pass One initial or secondary payment from Pool Three,
HHSC will sum the result from paragraph (4) of this subsection and
the result from paragraph (5) of this subsection to determine the
hospital's total projected DSH payment. In the event this sum plus
any previous payment amounts for the program year exceeds a hospital's
state payment cap, the payment amount will be reduced such that the
sum of the payment amount plus any previous payment amounts is equal
to the state payment cap. HHSC will sum all resulting excess funds
and redistribute that amount to qualifying non-state-owned hospitals
eligible for payments from Pool Three that have projected payments,
including any previous payment amounts for the program year, below
its state payment caps. For each such hospital, HHSC will:
(A) subtract the hospital's projected DSH payment plus
any previous payment amounts for the program year from its state payment
cap;
(B) sum the results of subparagraph (A) of this paragraph
for all hospitals; and
(C) compare the sum from subparagraph (B) of this paragraph
to the total excess funds calculated for all non-state-owned hospitals.
(i) If the sum of subparagraph (B) of this paragraph
is less than or equal to the total excess funds, HHSC will pay all
such hospitals up to the state payment cap.
(ii) If the sum of subparagraph (B) of this paragraph
is greater than the total excess funds, HHSC will calculate payments
to all such hospitals as follows.
(I) Divide the result of subparagraph (A) of this paragraph
for each hospital by the sum from subparagraph (B) of this paragraph.
(II) Multiply the ratio from subclause (I) of this
clause by the sum of the excess funds from all non-state-owned hospitals.
(III) Add the result of subclause (II) of this clause
to the projected total DSH payment for that hospital to calculate
a revised projected payment amount from Pools One, Two and Three after
Pass Two.
(7) Rural public hospital pool distribution and payment
calculation.
(A) HHSC will determine an allocation percentage such
that all rural public hospitals receive a uniform percentage of the
costs covered to fully utilize the rural public all funds allocation.
The percentage of cost covered will consider all previous DSH payments
for the program year, including the funds for the non-state hospitals.
(B) If a hospital's percentage of cost covered is greater
than the allocation percentage, it will not be eligible for any DSH
payments from the rural public hospital pool.
(C) If a hospital's percentage of cost covered is lower
than the allocation percentage, it will be allocated a projected payment
such that the percentage of cost covered is equal to the uniform percentage
in subparagraph (A) of this paragraph.
(D) Each rural public hospital is responsible for funding
the rural public payment multiplied by the non-federal percentage.
If the hospital does not fully fund the rural public payment, HHSC
will reduce the hospital's rural public payment to the level supported
by the amount of the intergovernmental transfer.
(8) Rural private hospital pool distribution and payment
calculation.
(A) If any funds remain from the rural public pool
described in paragraph (7) of this subsection, HHSC will allocate
a percentage of the remaining funds to rural private hospitals.
(B) HHSC will determine an allocation percentage such
that all rural private hospitals receive a uniform percentage of the
costs covered to fully utilize the rural public federal funds allocation.
The percentage of cost covered will consider all previous DSH payments
for the program year, including the funds for the non-state hospitals.
(C) If a hospital's percentage of cost covered is greater
than the allocation percentage, it will not be eligible for any DSH
payments from the rural private hospital pool.
(D) If a hospital's percentage of cost covered is lower
than the allocation percentage, it will be allocated a projected payment
such that the percentage of cost covered is equal to the uniform percentage
in subparagraph (B) of this paragraph.
Cont'd... |
