| (G) other HHSC goals and priorities.
(2) HHSC will limit the percentage rate increases determined
pursuant to this subsection to no more than the levels that are supported
by the amount described in paragraph (1)(A)(i) of this subsection.
Nothing in this section may be construed to limit the authority of
the state to require the sponsoring governmental entities to transfer
additional funds to HHSC following the reconciliation process described
in §353.1301(g) of this title, if the amount previously transferred
is less than the non-federal share of the amount expended by HHSC
in the SDA for this program.
(3) After determining the percentage of rate increase
using the process described in paragraphs (1) and (2) of this subsection,
HHSC will modify its contracts with the MCOs in the SDA to direct
the percentage rate increases.
(g) Application process; timing and amount of transfer
of non-federal share.
(1) The stakeholders in an SDA initiate the request
for HHSC to implement a uniform hospital rate increase program by
submitting an application using a form prescribed by HHSC.
(A) The stakeholders in the SDA, including hospitals,
sponsoring governmental entities, and MCOs, are expected to work cooperatively
to complete the application.
(B) The application provides an opportunity for stakeholders
to have input into decisions about which classes of hospital and services
are subject to the rate increases, and the percentage rate increase
applicable to each class, but HHSC retains the final decision-making
authority on these aspects of the program following the processes
described in subsections (d) - (f) of this section.
(C) HHSC must receive the completed application no
later than six months before the beginning of the program period or
modified program period in which the SDA proposes to participate.
(D) HHSC will process the application, contact SDA
representatives or stakeholders if there are questions, and notify
the stakeholders in the SDA of its decisions on the application, including
the classes of hospital eligible for the rate increase, the services
subject to the increase, the percentage rate increase applicable to
each class, and the total amount of IGT required for the first six
months of the program period.
(2) Sponsoring governmental entities must complete
the IGT for the first six months of the program period no later than
four months prior to the start of the program period, unless otherwise
instructed by HHSC. For example, for the program period beginning
September 1, 2017, HHSC must receive the IGT for the first six months
no later than May 1, 2017; for the modified program period beginning
March 1, 2018, HHSC must receive the IGT no later than November 1,
2017.
(3) Following the transfer of funds described in paragraph
(2) of this subsection, sponsoring governmental entities must transfer
additional IGT at such times and in such amounts as determined by
HHSC to be necessary to ensure the availability of funding of the
non-federal share of the state's expenditures under this section and
HHSC's compliance with the terms of its contracts with MCOs in the
SDA. In no event may transfers for directed increases in a program
period occur later than November 1 of the calendar year.
(4) HHSC will instruct sponsoring governmental entities
as to the required IGT amounts. Required IGT amounts will include
all costs associated with the uniform rate increase, including costs
associated with premium taxes, risk margins, and administration, plus
ten percent.
(h) Effective date of rate increases. HHSC will direct
MCOs to increase rates under this section beginning the first day
of the program period that includes the increased capitation rates
paid by HHSC to each MCO pursuant to the contract between them.
(i) Reconciliation. HHSC will reconcile the amount
of the non-federal funds actually expended under this section during
the program period with the amount of funds transferred to HHSC by
the sponsoring governmental entities for that same period using the
methodology described in §353.1301(g) of this subchapter.
(j) Recoupment. Payments under this section may be
subject to recoupment as described in §353.1301(k) of this subchapter.
(k) December 2017 limited eligibility. Notwithstanding
the other provisions of this section, any SDA that received approval
from CMS by April 15, 2017, may participate in the program described
in this section for dates of service beginning December 1, 2017. Sponsoring
governmental entities must complete the IGT for the period of December
1, 2017, through February 28, 2018, by a date to be determined by
HHSC.
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| Source Note: The provisions of this §353.1305 adopted to be effective April 9, 2017, 42 TexReg 1748; amended to be effective December 1, 2017, 42 TexReg 6369; amended to be effective August 9, 2020, 45 TexReg 5337; amended to be effective March 28, 2021, 46 TexReg 1977; amended to be effective January 17, 2022, 47 TexReg 85 |
