| (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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