| (A) To calculate a weight that will be applied to all
non-state providers, HHSC will divide the final hospital-specific
limit described in §355.8066(c)(2) of this division by the final
hospital-specific limit described in §355.8066(c)(2) of this
division that has not offset payments for third-party and Medicare
claims and encounters where Medicaid was a secondary payer. HHSC will
add 1 to the quotient. Any non-state provider that has a resulting
weight of less than 1 will receive a weight of 1.
(B) HHSC will make a first pass allocation by multiplying
the weight described in subsection (p)(2)(A) of this section by the
final remaining HSL calculated in the audit findings described in
subsection (o) of this section. HHSC will divide the product by the
total remaining HSLs for all non-state providers. HHSC will multiply
the quotient by the total amount of recouped dollars available for
redistribution described in subsection (p)(1) of this section.
(C) After the first pass allocation, HHSC will cap
non-state providers at its final remaining HSL. A second pass allocation
will occur in the event non-state providers were paid over its final
remaining HSL after the weight in subsection (p)(2)(A) of this section
was applied. HHSC will calculate the second pass by dividing the final
remaining HSL calculated in the audit findings described in subsection
(o) of this section by the total remaining HSLs for all non-state
providers after accounting for first pass payments. HHSC will multiply
the quotient by the total amount of funds in excess of total HSLs
for non-state providers capped at its total HSL.
(q) Advance Payments
(1) In a DSH program year in which payments will be
delayed pending data submission or for other reasons, HHSC may make
advance payments to hospitals that meet the eligibility requirements
described in subsection (c) of this section, meet a qualification
in subsection (d) of this section, meet the conditions of participation
in subsection (e) of this section, and submitted an acceptable disproportionate
share hospital application for the preceding DSH program year from
which HHSC calculated an annual maximum disproportionate share hospital
payment amount for that year.
(2) Advance payments are considered to be prior period
payments.
(3) A hospital that did not submit an acceptable disproportionate
share hospital application for the preceding DSH program year is not
eligible for an advance payment.
(4) If a partial year disproportionate share hospital
application was used to determine the preceding DSH program year's
payments, data from that application may be annualized for use in
computation of an advance payment amount.
(5) The amount of the advance payments:
(A) are divided into three payments prior to a hospital
receiving its final DSH payment amount;
(B) in DSH program years 2020 and after a provider
that received a payment in the previous DSH program year is eligible
to receive an advanced payment, and the calculations for advanced
payment 1, 2, and 3 are as follows:
(i) HHSC determines a percentage of the pool to pay
out in the advanced payments; and
(ii) the pool amount is fed through the previous DSH
program year calculation to determine the advanced payments;
(C) in DSH program year 2024, HHSC will run the application
data for hospital applications through an updated DSH qualification
and calculation file to determine advanced payment eligibility and
amount to account for rule changes between program year 2023 and 2024
to prevent recoupments; and
(D) HHSC will determine the payment allocation for
the advances for 2025 and subsequent years by calculating a percentage
based on a hospital's payment in the preceding year divided by the
sum of all other hospitals' payment in the preceding year that are
eligible for an advance payment.
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| Source Note: The provisions of this §355.8065 adopted to be effective September 1, 2009, 34 TexReg 5662; amended to be effective August 22, 2010, 35 TexReg 7035; amended to be effective October 1, 2011, 36 TexReg 6146; amended to be effective September 19, 2012, 37 TexReg 7273; amended to be effective September 11, 2013, 38 TexReg 5859; amended to be effective September 1, 2014, 39 TexReg 6407; amended to be effective May 3, 2015, 40 TexReg 2259; amended to be effective June 25, 2019, 44 TexReg 3091; amended to be effective February 1, 2020, 45 TexReg 525; amended to be effective June 28,2021,46 TexReg 3857; amended to be effective June 20, 2023, 48 TexReg 3187 |
