| (A) The hospital must be in active pursuit of designation
or have obtained a trauma facility designation as defined in §780.004
and §§773.111 - 773.120, Texas Health and Safety Code, respectively,
and consistent with 25 TAC §157.125 (relating to Requirements
for Trauma Facility Designation) and §157.131 (relating to the
Designated Trauma Facility and Emergency Medical Services Account).
A hospital that has obtained its trauma facility designation must
maintain that designation for the entire DSH program year.
(B) HHSC will receive an annual report from the Office
of EMS/Trauma Systems Coordination regarding hospital participation
in regional trauma system development, application for trauma facility
designation, and trauma facility designation or active pursuit of
designation status before final qualification determination for interim
DSH payments. HHSC will use this report to confirm compliance with
this condition of participation by a hospital applying for DSH funds.
(C) The following hospital types are exempted from
the condition of participation described in this paragraph: Children's
Hospitals, IMDs, and State IMDs.
(4) Maintenance of local funding effort. A hospital
district in one of the state's largest MSAs or in a PMSA must not
reduce local tax revenues to its associated hospitals as a result
of disproportionate share funds received by the hospital. For this
provision to apply, the hospital must have more than 250 licensed
beds.
(5) Retention of and access to records. A hospital
must retain and make available to HHSC records and accounting systems
related to DSH data for at least five years from the end of each DSH
program year in which the hospital qualifies, or until an open audit
is completed, whichever is later.
(6) Compliance with audit requirements. A hospital
must agree to comply with the audit requirements described in subsection
(o) of this section.
(7) Merged hospitals. Merged hospitals are subject
to the application requirement in subsection (c)(3)(E) of this section.
If HHSC receives documents verifying the merger status with Medicare
prior to the deadline for submission of the DSH application, the merged
entity must meet all conditions of participation. If HHSC does not
receive the documents verifying the merger status with Medicare prior
to the deadline for submission of the DSH application, any proposed
merging hospitals that are receiving DSH payments must continue to
meet all conditions of participation as individual hospitals to continue
receiving DSH payments for the remainder of the DSH program year.
(8) Changes that may affect DSH participation. A hospital
receiving payments under this section must notify HHSC's Rate Analysis
Department within 30 days of changes in ownership, operation, provider
identifier, designation as a trauma facility or as a children's hospital,
or any other change that may affect the hospital's continued eligibility,
qualification, or compliance with DSH conditions of participation.
At the request of HHSC, the hospital must submit any documentation
supporting the change.
(f) State payment cap and hospital-specific limit calculation.
HHSC uses the methodology described in §355.8066 of this title
to calculate a state payment cap for each Medicaid hospital that applies
and qualifies to receive payments for the DSH program year under this
section, and a hospital-specific limit for each hospital that received
payments in a prior program year under this section. For payments
for each DSH program year beginning before October 1, 2017, the state
payment cap calculated as described in §355.8066 will be reduced
by the amount of prior payments received by each participating hospital
for that DSH program year. These prior payments will not be considered
anywhere else in the calculation.
(g) Distribution of available DSH funds. HHSC will
distribute the available DSH funds as defined in subsection (b)(2)
of this section among eligible, qualifying DSH hospitals using the
following priorities:
(1) State-owned teaching hospitals, state-owned IMDs,
and state chest hospitals. HHSC may reimburse state-owned teaching
hospitals, state-owned IMDs, and state chest hospitals an amount less
than or equal to their state payment caps, except that aggregate payments
to IMDs statewide may not exceed federally mandated reimbursement
limits for IMDs.
(2) Other hospitals. HHSC distributes the remaining
available DSH funds, if any, to other qualifying hospitals using the
methodology described in subsection (h) of this section.
(A) The remaining available DSH funds equal the lesser
of the funds as defined in subsection (b)(2) of this section less
funds expended under paragraph (1) of this subsection or the sum of
remaining qualifying hospitals' state payment caps.
(B) The remaining available general revenue funds equal
the funds as defined in subsection (b)(3) of this section.
(h) DSH payment calculation.
(1) Data verification. HHSC uses the methodology described
in §355.8066(e) of this title to verify the data used for the
DSH payment calculations described in this subsection. The verification
process includes:
(A) notice to hospitals of the data provided to HHSC
by Medicaid contractors; and
(B) an opportunity for hospitals to request HHSC review
of disputed data.
(2) Establishment of DSH funding pools. From the amount
of remaining DSH funds determined in subsection (g)(2) of this section,
HHSC will establish three DSH funding pools.
(A) Pool One.
(i) Pool One is equal to the sum of the remaining available
general revenue funds and associated federal matching funds; and
(ii) Pool One payments are available to all non-state-owned
hospitals, including non-state-owned public hospitals.
(B) Pool Two.
(i) Pool Two is equal to the lesser of:
(I) the amount of remaining DSH funds determined in
subsection (g)(2) of this section less the amount determined in paragraph
(2)(A) of this subsection multiplied by the FMAP in effect for the
program year; or
(II) the federal matching funds associated with the
intergovernmental transfers received by HHSC that make up the funds
for Pool Three; and
(ii) Pool Two payments are available to all non-state-owned
hospitals except for any urban public hospital as defined in subsection
(b)(46) of this section; rural public hospital as defined in subsection
(b)(36) of this section; or rural public-financed hospital as defined
in subsection (b)(37) of this section owned by or affiliated with
a governmental entity that does not transfer any funds to HHSC for
Pool Three as described in subparagraph (C)(iii) of this paragraph.
(C) Pool Three.
(i) Pool Three is equal to the sum of intergovernmental
transfers for DSH payments received by HHSC from governmental entities
that own and operate Urban public hospitals - Class one, governmental
entities that operate or are under lease contracts with an Urban public
hospital - Class two, and non-urban public hospitals.
(ii) Pool Three payments are available to the hospitals
that are operated by or under lease contracts with the governmental
entities described in clause (i) of this subparagraph that provide
intergovernmental transfers.
(iii) HHSC will allocate responsibility for funding
Pool Three as follows:
(I) Urban public hospitals - Class two. Each governmental
entity that operates or is under a lease contract with an Urban public
hospital - Class two is responsible for funding an amount equal to
the non-federal share of Pass One and Pass Two DSH payments from Pool
Two (calculated as described in paragraphs (4) and (5) of this subsection)
to that hospital.
(II) Non-urban public hospitals.
(-a-) Each governmental entity that operates or is
under a lease contract with a non-urban public hospital is responsible
for funding one-half of the non-federal share of the hospital's Pass
One and Pass Two DSH payments from Pool Two (calculated as described
in paragraphs (4) and (5) of this subsection) to that hospital.
(-b-) If general revenue available for Pool One does
not equal at least one-half of the non-federal share of non-urban
public hospitals' Pass One and Pass Two DSH payments from Pool Two,
each governmental entity that operates or is under a lease contract
with a non-urban public hospital is responsible for increasing its
funding of the non-federal share of that hospital's Pass One and Pass
Two DSH payments from Pool Two by an amount equal to the Pool One
general revenue shortfall associated with the hospital.
(III) Urban public hospitals - Class one. Each governmental
entity that owns and operates an Urban public hospital - Class one
is responsible for funding the non-federal share of the Pass One and
Pass Two DSH payments from Pool Two (calculated as described in paragraphs
(4) and (5) of this subsection) to its affiliated hospital and a portion
of the non-federal share of the Pass One and Pass Two DSH payments
from Pool Two to Cont'd... |
