| (E) Each governmental entity that owns and operates
a transferring public hospital is responsible for funding the non-federal
share of the DSH payments from the rural private hospital pool to
rural private hospitals. If an entity transfers less than the suggested
amount, HHSC will reduce the rural private hospitals' payments to
the level supported by the amount of the intergovernmental transfer.
(F) Any remaining funds from the percentage allocation
described in subparagraph (A) of this paragraph and any undistributed
funds from this pool will be redistributed back into the pool two
secondary payment as described in paragraph (4) of this subsection.
(9) Pass Three - If any portion non-federal share of
the available DSH funds is not fully funded, the remaining allocation
will be available to non-urban public hospitals that met the funding
requirements described in paragraph (2)(C)(iii)(I) of this subsection.
(A) For each non-urban public hospital that met the
funding requirements described in paragraph (2)(C)(iii)(I) 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) - (8) 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 non-urban public 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:
(i) determine remaining available funds by subtracting
payment amounts for all DSH hospitals calculated in paragraphs (4)
- (8) of this subsection from the amount in subsection (g)(3) of this
section;
(ii) determine the total additional allocation supported
by an intergovernmental transfer by summing the amounts supported
by intergovernmental transfers identified in subparagraph (C) of this
paragraph;
(iii) determine an available proportion statistic by
dividing the remaining available funds from clause (i) of this subparagraph
by the total additional allocation supported by an intergovernmental
transfer from clause (ii) of this subparagraph; and
(iv) multiply each intergovernmental transfer supported
payment from subparagraph (C) of this paragraph by the proportion
statistic determined in clause (iii) of this subparagraph. The resulting
product will be the additional allowable allocation for the payment.
(E) Non-urban public hospitals that do not meet the
funding requirements of paragraph (2)(C)(iii)(I) of this subsection
are not eligible for participation on Pass Three.
(10) Reallocating funds if hospital closes, loses its
license or eligibility, or files bankruptcy. If a hospital closes,
loses its license, loses its Medicare or Medicaid eligibility, or
files bankruptcy before receiving DSH payments for all or a portion
of a DSH program year, HHSC will determine the hospital's eligibility
to receive DSH payments going forward on a case-by-case basis. In
making the determination, HHSC will consider multiple factors including
whether the hospital was in compliance with all requirements during
the program year and whether it can meet the audit requirements described
in subsection (o) of this section. If HHSC determines that the hospital
is not eligible to receive DSH payments going forward, HHSC will notify
the hospital and reallocate that hospital's disproportionate share
funds to state hospitals then amongst all DSH hospitals in the same
category that are eligible for additional payments.
(11) HHSC will give notice of the amounts determined
in this subsection.
(12) The sum of the annual payment amounts for state
owned and non-state owned IMDs are summed and compared to the federal
IMD limit. If the sum of the annual payment amounts exceeds the federal
IMD limit, the non-state owned IMDs are reduced first on a pro-rata
basis so that the sum is equal to the federal IMD limit. In the case
that the non-state owned IMD payments are eliminated and the payments
for the state owned IMD still exceed the federal IMD limit, then the
state owned IMD payments will be reduced on a pro-rata basis until
they equal the federal IMD limit.
(13) For any DSH program year for which HHSC has calculated
the hospital-specific limit described in §355.8066(c)(2) of this
chapter, HHSC will compare the interim DSH payment amount as calculated
in subsection (h) of this section to the hospital-specific limit.
(A) HHSC will limit the payment amount to the hospital-specific
limit if the payment amount exceeds the hospital's hospital-specific
limit.
(B) HHSC will redistribute dollars made available as
a result of the capping described in subparagraph (A) of this paragraph
to providers eligible for additional payments subject to the hospital-specific
limits, as described in subsection (l) of this section.
(i) Hospital located in a state or federal natural
disaster area. A hospital that is located in a county that is declared
a state or federal natural disaster area and that was participating
in the DSH program at the time of the natural disaster may request
that HHSC determine its DSH qualification and interim reimbursement
payment amount under this subsection for subsequent DSH program years.
The following conditions and procedures will apply to all such requests
received by HHSC.
(1) The hospital must submit its request in writing
to HHSC with its annual DSH application.
(2) If HHSC approves the request, HHSC will determine
the hospital's DSH qualification using the hospital's data from the
DSH data year prior to the natural disaster. However, HHSC will calculate
the one percent Medicaid minimum utilization rate, the state payment
cap, and the payment amount using data from the DSH data year. The
hospital-specific limit will be computed based on the actual data
for the DSH program year.
(3) HHSC will notify the hospital of the qualification
and interim reimbursement.
(j) HHSC determination of eligibility or qualification.
HHSC uses the methodology described in §355.8066(e) of this division
to verify the data and other information used to determine eligibility
and qualification under this section. The verification process includes:
(1) notice to hospitals of the data provided to HHSC
by Medicaid contractors; and
(2) an opportunity for hospitals to request HHSC review
of disputed data and other information the hospital believes is erroneous.
(k) Disproportionate share funds held in reserve.
(1) If HHSC has reason to believe that a hospital is
not in compliance with the conditions of participation listed in subsection
(e) of this section, HHSC will notify the hospital of possible noncompliance.
Upon receipt of such notice, the hospital will have 30 calendar days
to demonstrate compliance.
(2) If the hospital demonstrates compliance within
30 calendar days, HHSC will not hold the hospital's DSH payments in
reserve.
(3) If the hospital fails to demonstrate compliance
within 30 calendar days, HHSC will notify the hospital that HHSC is
holding the hospital's DSH payments in reserve. HHSC will release
the funds corresponding to any period for which a hospital subsequently
demonstrates that it was in compliance. HHSC will not make DSH payments
for any period in which the hospital is out of compliance with the
conditions of participation listed in subsection (e)(1) and (2) of
this section. HHSC may choose not to make DSH payments for any period
in which the hospital is out of compliance with the conditions of
participation listed in subsection (e)(3) - (7) of this section.
Cont'd... |
