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can satisfy the requirement to cooperate in the reconciliation process
as described in subsection (i) of this section.
(B) A hospital must notify HHSC Rate Analysis Department
in writing within 30 days of the filing of bankruptcy or of changes
in ownership, operation, licensure, Medicare or Medicaid enrollment,
or affiliation that may affect the hospital's continued eligibility
for payments under this section.
(d) Source of funding. The non-federal share of funding
for payments under this section is limited to timely receipt by HHSC
of public funds from a governmental entity.
(e) Payment frequency. HHSC will distribute waiver
payments on a schedule to be determined by HHSC and posted on HHSC's
website.
(f) Funding limitations.
(1) Payments made under this section are limited by
the maximum aggregate amount of funds allocated to the provider's
uncompensated-care pool for the demonstration year. If payments for
uncompensated care for an uncompensated-care pool attributable to
a demonstration year are expected to exceed the aggregate amount of
funds allocated to that pool by HHSC for that demonstration year,
HHSC will reduce payments to providers in the pool as described in
subsection (g)(5) of this section.
(2) HHSC will establish the following seven uncompensated-care
pools: a state-owned hospital pool; a large public hospital pool;
a small public hospital pool; a private hospital pool; a physician
group practice pool; a governmental ambulance provider pool; and a
publicly owned dental provider pool as follows:
(A) The state-owned hospital pool.
(i) The state-owned hospital pool funds uncompensated-care
payments to state-owned teaching hospitals, state-owned IMDs and state
chest hospitals.
(ii) HHSC will determine the allocation for this pool
at an amount less than or equal to the total annual maximum uncompensated-care
payment amount for these hospitals as calculated in subsection (g)(2)
of this section.
(B) Set-aside amounts. HHSC will determine set-aside
amounts as follows:
(i) For small public hospitals:
(I) that are also rural hospitals:
(-a-) Divide the amount of funds approved by CMS for
uncompensated-care payments for the demonstration year by the amount
of funds approved by CMS for uncompensated-care payments for the 2013
demonstration year and round the result to four decimal places.
(-b-) Determine the small rural public hospital set-aside
amount by multiplying the value from item (-a-) of this subclause
by the sum of the interim hospital specific limits from subsection
(g)(2)(A) of this section for all small rural public hospitals that
are eligible to receive uncompensated-care payments under this section
and that meet the definition of a small public hospital from subsection
(b)(21) of this section. Truncate the resulting value to zero decimal
places.
(II) that are also urban RRCs, for DY 7 only, determine
the small public urban RRC set-aside amount by multiplying by 54%
the sum of the interim hospital specific limits from subsection (g)(2)(A)
of this section for all small public urban RRCs that are eligible
to receive uncompensated-care payments under this section and that
meet the definition of an urban RRC from subsection (b)(26) of this
section. Truncate the resulting value to zero decimal places.
(ii) For private hospitals:
(I) that are also rural hospitals:
(-a-) Divide the amount of funds approved by CMS for
uncompensated-care payments for the demonstration year by the amount
of funds approved by CMS for uncompensated-care payments for the 2013
demonstration year and round the result to four decimal places.
(-b-) Determine the private rural hospital set-aside
amount by multiplying the value from item (-a-) of this subclause
by the sum of the interim hospital specific limits from subsection
(g)(2)(A) of this section for all private rural hospitals that are
eligible to receive uncompensated-care payments under this section
and that meet the definition of a small public hospital from subsection
(b)(21) of this section. Truncate the resulting value to zero decimal
places.
(II) that are also urban RRCs, for DY 7 only, determine
the private urban RRC set-aside amount by multiplying by 54% the sum
of the interim hospital specific limits from subsection (g)(2)(A)
of this section for all private urban RRCs that are eligible to receive
uncompensated-care payments under this section and that meet the definition
of an urban RRC from subsection (b)(26) of this section. Truncate
the resulting value to zero decimal places.
(iii) Determine the total set-aside amount by summing
the results of subclauses (i)(I), (i)(II), (ii)(I), and (ii)(II) of
this subparagraph.
(C) Non-state-owned provider pools. HHSC will allocate
the remaining available uncompensated-care funds, if any, and the
set-aside amount among the non-state-owned provider pools as described
in this subparagraph. The remaining available uncompensated-care funds
equal the amount of funds approved by CMS for uncompensated-care payments
for the demonstration year less the sum of funds allocated to the
state-owned hospital pool under subparagraph (A) of this paragraph
and the set-aside amount from subparagraph (B) of this paragraph.
(i) HHSC will allocate the funds among non-state-owned
provider pools based on the following amounts:
(I) Large public hospitals:
(-a-) The sum of the interim hospital specific limits
from subsection (g)(2)(A) of this section for all large public hospitals,
as defined in subsection (b)(14) of this section, eligible to receive
uncompensated-care payments under this section; plus
(-b-) An amount equal to the IGTs transferred to HHSC
by large public hospitals to support DSH payments to themselves and
private hospitals for the same demonstration year.
(II) Small public hospitals:
(-a-) The sum of the interim hospital specific limits
from subsection (g)(2)(A) of this section for all non-rural and non-urban
RRC small public hospitals, as defined in subsection (b)(21) of this
section, eligible to receive uncompensated-care payments under this
section; plus
(-b-) An amount equal to the IGTs transferred to HHSC
by small public hospitals to support DSH payments to themselves for
Pass One and Pass Two payments for the same demonstration year.
(III) Private hospitals: The sum of the interim hospital
specific limits from subsection (g)(2)(A) of this section for all
non-rural and non-urban RRC private hospitals, as defined in subsection
(b)(16) of this section, eligible to receive uncompensated-care payments
under this section.
(IV) Physician group practices: The sum of the unreimbursed
uninsured costs and Medicaid shortfall for physician group practices,
as described in §355.8202(g)(2)(A) of this title (relating to
Waiver Payments to Physician Group Practices for Uncompensated Care).
(V) Governmental ambulance providers: The sum of the
uncompensated care costs multiplied by the federal medical assistance
percentage (FMAP) in effect during the cost reporting period for governmental
ambulance providers, as described in §355.8600 of this title
(relating to Reimbursement Methodology for Ambulance Services). Estimated
amounts may be used if actual data is not available at the time calculations
are performed.
(VI) Publicly-owned dental providers: The sum of the
total allowable cost minus any payments for publicly owned dental
providers, as described in §355.8441 of this title (relating
to Reimbursement Methodologies for Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) Services). Estimated amounts may be used if
actual data is not available at the time calculations are performed.
(ii) HHSC will sum the amounts calculated in clause
(i) of this subparagraph.
(iii) HHSC will calculate the aggregate limit for each
non-state-owned provider pool as follows:
(I) To determine the large public hospital pool aggregate
limit:
(-a-) multiply the remaining available uncompensated-care
funds, from this subparagraph, by the amount calculated in clause
(i)(I) of this subparagraph; and
(-b-) divide the result from item (-a-) of this subclause
by the amount calculated in clause (ii) of this subparagraph and truncate
to zero decimal places.
(II) To determine the small public hospital pool aggregate
limit:
(-a-) multiply the remaining available uncompensated-care
funds from this subparagraph by the amount calculated in clause (i)(II)
of this subparagraph;
(-b-) divide the result from item (-a-) of this subclause
by the amount calculated in clause (ii) of this subparagraph and truncate
to zero decimal places; and
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