| (-b-) the difference between the capped payment amount
from subclause (I) or (II) of this clause and the prior period payments
from subparagraph (B)(i) of this paragraph.
(IV) HHSC will allocate to each non-state-owned hospital
the revised maximum uncompensated-care payment amount from subclause
(III) of this clause.
(7) Non-state-owned hospital SDA sub-pools. After HHSC
completes the calculations described in paragraph (6) of this subsection,
HHSC will place each non-state-owned hospital into a sub-pool based
on the hospital's geographic location in a designated Medicaid SDA
for purposes of the calculations described in subsection (h) of this
section.
(8) Prohibition on duplication of costs. Eligible uncompensated-care
costs cannot be reported on multiple uncompensated-care applications,
including uncompensated-care applications for other programs. Reporting
on multiple uncompensated-care applications is duplication of costs.
(9) Advance payments.
(A) In a demonstration year in which uncompensated-care
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)(2) of this section and submitted
an acceptable uncompensated-care application for the preceding demonstration
year from which HHSC calculated an annual maximum uncompensated-care
payment amount for that year.
(B) The amount of the advance payments will:
(i) in demonstration year nine, be based on uninsured
charity-care costs reported by the hospital on schedule S-10 of the
CMS 2552-10 cost report used for purposes of sizing the UC pool, or
on documentation submitted for that purpose by each hospital not required
to submit schedule S-10 with their cost report; and
(ii) in demonstration years ten and after, be a percentage,
to be determined by HHSC, of the annual maximum uncompensated-care
payment amount calculated by HHSC for the preceding demonstration
year.
(C) Advance payments are considered to be prior period
payments as described in paragraph (6)(B)(i) of this subsection.
(D) A hospital that did not submit an acceptable uncompensated-care
application for the preceding demonstration year is not eligible for
an advance payment.
(E) If a partial year uncompensated-care application
was used to determine the preceding demonstration year's payments,
data from that application may be annualized for use in computation
of an advance payment amount.
(h) Payment methodology.
(1) Notice. Prior to making any payment described in
subsection (g) of this section, HHSC will give notice of the following
information:
(A) the payment amount for each hospital in a pool
or sub-pool for the payment period (based on whether the payment is
made quarterly, semi-annually, or annually);
(B) the maximum IGT amount necessary for hospitals
in a pool or sub-pool to receive the amounts described in subparagraph
(A) of this paragraph; and
(C) the deadline for completing the IGT.
(2) Payment amount. The amount of the payment to hospitals
in each pool or sub-pool will be determined based on the amount of
funds transferred by the affiliated governmental entities as follows:
(A) If the governmental entities transfer the maximum
amount referenced in paragraph (1) of this subsection, the hospitals
in the pool or sub-pool will receive the full payment amount calculated
for that payment period.
(B) If the governmental entities do not transfer the
maximum amount referenced in paragraph (1) of this subsection, each
hospital in the pool or sub-pool will receive a portion of its payment
amount for that period, based on the hospital's percentage of the
total payment amounts for all hospitals in the pool or sub-pool.
(3) Final payment opportunity. Within payments described
in this section, governmental entities that do not transfer the maximum
IGT amount described in paragraph (1) of this subsection during a
demonstration year will be allowed to fund the remaining payments
to hospitals in the pool or sub-pool at the time of the final payment
for that demonstration year. The IGT will be applied in the following
order:
(A) to the final payments up to the maximum amount;
and
(B) to remaining balances for prior payment periods
in the demonstration year.
(i) Reconciliation. HHSC will reconcile actual costs
incurred by the hospital for the demonstration year with uncompensated-care
payments, if any, made to the hospital for the same period:
(1) If a hospital received payments in excess of its
actual costs, the overpaid amount will be recouped from the hospital,
as described in subsection (j) of this section.
(2) If a hospital received payments less than its actual
costs, and if HHSC has available waiver funding for the demonstration
year in which the costs were accrued, the hospital may receive reimbursement
for some or all of those actual documented unreimbursed costs.
(3) Each hospital that received an uncompensated-care
payment during a demonstration year must cooperate in the reconciliation
process by reporting its actual costs and payments for that period
on the form provided by HHSC for that purpose, even if the hospital
closed or withdrew from participation in the uncompensated-care program.
If a hospital fails to cooperate in the reconciliation process, HHSC
may recoup the full amount of uncompensated-care payments to the hospital
for the period at issue.
(j) Recoupment.
(1) In the event of an overpayment identified by HHSC
or a disallowance by CMS of federal financial participation related
to a hospital's receipt or use of payments under this section, HHSC
may recoup an amount equivalent to the amount of the overpayment or
disallowance. The non-federal share of any funds recouped from the
hospital will be returned to the entity that owns or is affiliated
with the hospital.
(2) Payments under this section may be subject to adjustment
for payments made in error, including, without limitation, adjustments
under §371.1711 of this title (relating to Recoupment of Overpayments
and Debts), 42 CFR Part 455, and Chapter 403 of the Texas Government
Code. HHSC may recoup an amount equivalent to any such adjustment.
(3) HHSC may recoup from any current or future Medicaid
payments as follows:
(A) HHSC will recoup from the hospital against which
any overpayment was made or disallowance was directed.
(B) If, within 30 days of the hospital's receipt of
HHSC's written notice of recoupment, the hospital has not paid the
full amount of the recoupment or entered into a written agreement
with HHSC to do so, HHSC may withhold any or all future Medicaid payments
from the hospital until HHSC has recovered an amount equal to the
amount overpaid or disallowed.
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