| (a) The Texas Health and Human Services Commission
(HHSC) uses the methodology in this subsection to calculate Inpatient
Direct Graduate Medical Education (GME) cost reimbursement for state-owned
or state-operated teaching hospitals.
(1) Effective September 1, 2008, HHSC or its designee
may reimburse a state-owned or state-operated teaching hospital with
an approved medical residency program the hospital's inpatient direct
GME cost for hospital cost reports beginning with state fiscal year
2009.
(2) Reimbursement of inpatient direct GME cost for
state-owned or state- operated teaching hospitals:
(A) Inpatient direct GME cost, as specified under methods
and procedures set out in the Social Security Act, Title XVIII, as
amended, effective October 1, 1982, by Public Law 97-248 is calculated
under similar methods for each hospital having inpatient direct GME
costs on its tentative or final audited cost report.
(B) Definitions.
(i) Base year average per resident amount--the hospital's
Medicaid allowable inpatient direct GME cost as reported on CMS Form
2552-96, Hospital Cost Report ending in state fiscal year 2007; Worksheet
B; Part I; Column 26; Line 95, divided by the unweighted FTE residents
from Worksheet S-3; Part I; Line 25.
(ii) Current FTE residents--the hospital's number of
full time equivalent (FTE) interns, residents, or fellows who participate
in a program that is determined by HHSC to be a properly approved
medical residency program including a program in osteopathy, dentistry,
or podiatry, as required in order to become certified by the appropriate
specialty board, as reported on CMS Form 2552-96, Hospital Cost Report;
Worksheet S-3; Part I; Line 25.
(iii) GME Medicaid inpatient utilization percentage--the
hospital's proportion of paid Medicaid inpatient days, including managed
care days, as reported on CMS Form 2552-96, Hospital Cost Report adjusted
to Medicaid Claim Summary Report; Worksheet S-3; Part 1; Line 12;
Column 5, divided by the hospital's total inpatient days, as reported
on Worksheet S-3; Part 1; Column 6, Lines 12, 14 (subprovider days),
and 26 (observation days). Medicaid inpatient days and total inpatient
days will include inpatient nursery days.
(C) HHSC calculates the total GME payments for each
hospital as follows:
(i) multiplies the base year average per resident amount
by the applicable Centers for Medicare and Medicaid Services (CMS)
Prospective Payment System Hospital Market Basket index;
(ii) multiplies the results in clause (i) of this subparagraph
by the number of current full-time equivalent (FTE) residents; and
(iii) multiplies the results in clause (ii) of this
subparagraph by the GME Medicaid inpatient utilization percentage,
which results in the total GME payments.
(D) Inpatient direct GME costs are removed from the
reimbursement methodology and not used in the calculation of the provider's
inpatient cost settlement.
(E) The GME interim payments will be reimbursed on
a quarterly basis only after hospital services have been rendered.
The interim payments are payable within 90 days of the receipt of
the hospital's quarterly resident FTE data. Each hospital's quarterly
resident FTE data will be divided by 4 to determine the average resident
FTEs for each quarter. The interim payments will be reconciled and
settled based on audited final cost report data.
(F) To receive GME payments from HHSC, a state-owned
or state-operated teaching hospital must be enrolled as a Medicaid
provider with HHSC and provide intergovernmental transfers to HHSC
to fund the non-federal portion of reimbursement for GME costs.
(b) HHSC uses the methodology in this subsection to
calculate reimbursement for GME cost reimbursement for non-state government-owned
and operated teaching hospitals.
(1) Effective October 1, 2018, HHSC or its designee
may reimburse a non-state government-owned and operated teaching hospital
with an approved medical residency program the hospital's estimated
Medicaid inpatient direct GME cost.
(2) Definitions.
(A) Non-state government-owned and operated teaching
hospital--a hospital with a properly approved medical residency program
that is owned and operated by a local government entity, including
but not limited to, a city, county, or hospital district.
(B) FTE residents--the hospital's number of unweighted
full time equivalent (FTE) interns, residents, or fellows who participate
in a program that is determined by HHSC to be a properly approved
medical residency program including a program in osteopathy, dentistry,
or podiatry, as required in order to become certified by the appropriate
specialty board, as reported on the Hospital Cost Report; CMS Form
2552-10; Worksheet S-3; Part 1; Column 9; Line 27.
(C) Medicare per resident amount (PRA)--average direct
cost per medical resident, as reported on the Hospital Cost Report;
CMS Form 2552-10; Worksheet E-4; Line 18.
(D) GME Medicaid inpatient utilization percentage--the
hospital's proportion of Medicaid inpatient days, including managed
care days, divided by the hospital's total inpatient days, as reported
on Hospital Cost Report; CMS Form 2552-10; Worksheet S-3; Part 1;
columns 7 and 8.
(3) HHSC calculates the total annual GME payment for
each hospital as follows:
(A) multiplies the FTE residents by the Medicare per
resident amount;
(B) multiplies the results in subparagraph (A) of this
paragraph by the GME Medicaid inpatient utilization percentage.
(4) On October 1 of each year, the cost report most
recently submitted to HHSC or its designee, will be used for the annual
GME payment calculation.
(5) To receive GME payments from HHSC, a non-state
government-owned and operated teaching hospital must be enrolled as
a Medicaid provider with HHSC and provide intergovernmental transfers
to HHSC to fund the non-federal portion of reimbursement for GME costs.
(6) Payments under this subchapter will be made on
a semi-annual basis.
(c) HHSC uses the methodology in this subsection to
calculate reimbursement for GME cost reimbursement for teaching hospitals
not described in subsections (a) or (b) of this section.
(1) Effective April 1, 2019, HHSC or its designee may
reimburse a non-government owned or operated teaching hospital with
an approved medical residency program the hospital's estimated Medicaid
inpatient direct GME cost.
(2) Definitions.
(A) Teaching hospital--a hospital with a properly approved
medical residency program.
(B) FTE residents--the hospital's number of unweighted
full time equivalent (FTE) interns, residents, or fellows who participate
in a program that is determined by HHSC to be a properly approved
medical residency program including a program in osteopathy, dentistry,
or podiatry, as required in order to become certified by the appropriate
specialty board:
(i) as reported on the Hospital Cost Report; CMS Form
2552-10; Worksheet S-3; Part 1; Column 9; Line 27, or
(ii) for hospitals excluded from the Prospective Payment
System (PPS) for Medicare, as reported on the Hospital Cost Report;
CMS Form 2552-10; Worksheet E-4; the sum of Column 1, Line 6 and Column
2, Line 10.01.
(C) Interim Medicare per resident amount (PRA)--If
a hospital does not have a Medicare PRA reported on the Hospital Cost
Report; CMS Form 2552-10; Worksheet E-4; Line 18, then HHSC shall
establish an interim Medicare PRA as follows:
(i) The annual estimated cost of FTE residents will
be the amount on Hospital Cost Report; CMS Form 2552-10; Worksheet
B, Part I, Column 25, Line 118.
(ii) Divided by the FTE residents as determined in
subparagraph (B) of this paragraph.
(D) Medicare per resident amount (PRA)--average direct
cost per medical resident, as reported on the Hospital Cost Report;
CMS Form 2552-10; Worksheet E-4; Line 18.
(E) GME Medicaid inpatient utilization percentage--the
hospital's proportion of Medicaid inpatient days, including managed
care days, divided by the hospital's total inpatient days, as reported
on Hospital Cost Report; CMS Form 2552-10; Worksheet S-3; Part 1;
columns 7 and 8.
(i) The numerator (total Medicaid inpatient days including
managed care days) is the sum of Worksheet S-3, Part I, column 7,
Lines 1 through 4, 8 through 13, 16 through 18, 28, and 30 through
32 and all subscripts of these lines.
(ii) The denominator (total inpatient days) is the
sum of Worksheet S-3, Part I, column 8, Lines 1 through 4, 8 through
13, 16 through 18, 28, and 30 through 32 and all subscripts of these
lines.
(3) HHSC calculates the total annual GME payment for
each hospital as follows:
(A) multiplies the FTE residents by the Medicare PRA
or the interim Medicare PRA;
Cont'd... |
