| (I) Multiply each hospital's total Pass Two projected
payment amount from Pools One and Two from paragraph (5) of this subsection,
after performing the recalculation described in clause (iii) of this
subparagraph, by the percentage of the hospital's total Pass One projected
payment amount accruing from Pool Two from paragraph (4)(B)(v) of
this subsection, after performing the recalculation described in clause
(iii) of this subparagraph. The result is the hospital's Pass Two
projected payment amount from Pool Two;
(II) Subtract the hospital's Pass Two projected payment
amount from Pool Two from subclause (I) of this clause from the hospital's
total Pass Two projected payment amount from Pools One and Two from
paragraph (5) of this subsection, after performing the recalculation
described in clause (iii) of this subparagraph. The result is the
hospital's Pass Two projected payment amount from Pool One;
(III) Sum the total Pass Two projected payment amounts
from Pool Two, calculated as described in subclause (I) of this clause,
for all Urban public hospitals - Class one;
(IV) Multiply the result of clause (ii)(I) of this
subparagraph for the hospital by the result of subclause (III) of
this clause to determine the Pass Two payment from Pool Two for the
hospital; and
(V) Sum the results of subclauses (II) and (IV) of
this clause to determine the total Pass Two payment from Pools One
and Two for that hospital; and
(v) Use the results of this subparagraph in the calculations
described in paragraphs (6) and (7) of this subsection.
(6) Pass One distribution and payment calculation for
Pool Three.
(A) HHSC will calculate the initial payment from Pool
Three as follows:
(i) For each Urban public hospital - Class one and
Class two--
(I) multiply its total Pool One and Pool Two payments
after Pass Two from paragraph (5) of this subsection by the percentage
of the hospital's total Pass One projected payment amount accruing
from Pool Two from paragraph (4)(B)(v) of this subsection;
(II) divide the result from subclause (I) of this clause
by the FMAP for the program year; and
(III) multiply the result from subclause (II) 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) multiply its total Pool One and Pool Two payments
after Pass Two from paragraph (5) of this subsection by the percentage
of the hospital's total Pass One projected payment amount accruing
from Pool Two from paragraph (4)(B)(v) of this subsection;
(II) divide the result from subclause (I) of this clause
by the FMAP for the program year; and
(III) multiply the result from subclause (II) of this
clause by the non-federal percentage and multiply by 0.50. The result
is the Pass One initial payment from Pool Three for these hospitals.
(IV) If paragraph (2)(C)(iii)(II)(-b-) of this subsection
is invoked, the 0.50 referenced in subclause (III) of this clause
will be increased to represent the increased proportion of the non-federal
share of non-urban public hospitals' Pass One and Pass Two DSH payments
from Pool Two required to be funded by these hospitals' associated
governmental entities.
(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 Urban public hospital - Class one as follows:
(i) Sum the intergovernmental transfers made on behalf
of all Urban public hospitals - Class one;
(ii) For each Urban public hospital - Class one, divide
the intergovernmental transfer made on behalf of that hospital by
the sum of the intergovernmental transfers made on behalf of all Urban
public hospitals - Class one 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; and
(v) Multiply the result from clause (ii) of this subparagraph
by the result from clause (iv) of this subparagraph for each Urban
public hospital - Class One. 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.
(7) 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 (5) of this subsection and
the result from paragraph (6) 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
their 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 their 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.
(8) Pass Three - additional allocation of DSH funds
for rural public and rural public-financed hospitals. Rural public
hospitals or rural public-financed hospitals that met the funding
requirements described in paragraph (2)(C) of this subsection may
be eligible for DSH funds in addition to the projected payment amounts
calculated in paragraphs (4) - (7) of this subsection.
(A) For each rural public hospital or rural public
financed hospital that met the funding requirements described in paragraph
(2)(C) of this subsection, HHSC will determine the projected payment
amount plus any previous payment amounts for the program year calculated
in accordance with paragraphs (4) - (7) of this subsection, as appropriate.
(B) HHSC will subtract each hospital's projected payment
amount plus any previous payment amounts for the program year from
subparagraph (A) of this paragraph from each hospital's state payment
cap to determine the maximum additional DSH allocation.
(C) The governmental entity that owns the hospital
or leases the hospital may provide the non-federal share of funding
through an intergovernmental transfer to fund up to the maximum additional
DSH allocation calculated in subparagraph (B) of this paragraph. These
governmental entities will be queried by HHSC as to the amount of
funding they intend to provide through an intergovernmental transfer
for this additional allocation. The query may be conducted through
e-mail, through the various hospital associations or through postings
on the HHSC website.
(D) Prior to processing any full or partial DSH payment
that includes an additional allocation of DSH funds as described in
this paragraph, HHSC will determine if such a payment would cause
total DSH payments for the full or partial payment to exceed the available
DSH funds for the payment as described in subsection (b)(2) of this
section. If HHSC makes such a determination, it will reduce the DSH
payment amounts rural public and rural public-financed hospitals are
eligible to receive through the additional allocation as required
to remain within the available DSH funds for the payment. This reduction
will be applied proportionally to all additional allocations. HHSC
will:
Cont'd... |
