| private hospitals. For funding payments to private
hospitals, HHSC will initially suggest an amount in proportion to
each Urban public hospital - Class one's individual state payment
cap relative to total state payment caps for all Urban public hospitals
- Class one. If an entity transfers less than the suggested amount,
HHSC will take the steps described in paragraph (5)(F) of this subsection.
(IV) Following the calculations described in paragraphs
(4) and (5) of this subsection, HHSC will notify each governmental
entity of its allocated intergovernmental transfer amount.
(3) Weighting factors.
(A) HHSC will assign each non-urban public hospital
a weighting factor that is calculated as follows:
(i) Determine the non-federal percentage in effect
for the program year and multiply by 0.50.
(ii) Add 1.00 to the result from clause (i) of this
subparagraph and round the result to two decimal places; this rounded
sum is the non-urban public hospital weighting factor.
(iii) If paragraph (2)(C)(iii)(II)(-b-) of this subsection
is invoked, the 0.50 referenced in clause (i) of this subparagraph
will be increased to represent the increased proportion of the non-federal
share of non-urban public hospitals' Pass One and Pass Two DSH payments
from Pool Two required to be funded by these hospitals' associated
governmental entities.
(B) All other DSH hospitals not described in subparagraph
(A) of this paragraph will be assigned a weighting factor of 1.00,
except for DSH program years beginning before October 1, 2017, HHSC
will assign weighting factors as follows to each non-state DSH hospital:
(i) Other Insurance Weight. HHSC will divide the amount
of third party commercial insurance payments for that hospital from
the DSH data year by the state payment cap calculated according to
§355.8066(c)(1)(D)(ii)(I)(-b-), except that costs are reduced
by payments from all payors.
(I) The result, if greater than 1, will be used as
a weighting factor.
(II) If the result is less than 1, no weighting factor
will be applied.
(ii) Year-To-Date Payment Weight. HHSC will assign
a weighting factor of 20 to any hospital that did not receive any
prior payments for that DSH program year. This weighting factor will
be added to the weighting factor calculated in clause (i) of this
subparagraph.
(4) Pass One distribution and payment calculation for
Pools One and Two.
(A) HHSC will calculate each hospital's total DSH days
as follows:
(i) Weighted Medicaid inpatient days are equal to the
hospital's Medicaid inpatient days multiplied by the appropriate weighting
factors from paragraph (3) of this subsection.
(ii) Low-income days are equal to the hospital's low-income
utilization rate as calculated in subsection (d)(2) of this section
multiplied by the hospital's total inpatient days as defined in subsection
(b)(18) of this section.
(iii) Weighted low-income days are equal to the hospital's
low-income days multiplied by the appropriate weighting factors from
paragraph (3) of this subsection.
(iv) Total DSH days equal the sum of weighted Medicaid
inpatient days and weighted low-income days.
(B) Using the results from subparagraph (A) of this
paragraph, HHSC will:
(i) Divide each hospital's total DSH days from subparagraph
(A)(iv) of this paragraph by the sum of total DSH days for all non-state-owned
DSH hospitals to obtain a percentage.
(ii) Multiply each hospital's percentage as calculated
in clause (i) of this subparagraph by the amount determined in paragraph
(2)(A) of this subsection to determine each hospital's Pass One projected
payment amount from Pool One.
(iii) Multiply each hospital's percentage as calculated
in clause (i) of this subparagraph by the amount determined in paragraph
(2)(B)(i)(I) or (II) of this subsection, as appropriate, to determine
each hospital's Pass One projected payment amount from Pool Two.
(iv) Sum each hospital's Pass One projected payment
amounts from Pool One and Pool Two, as calculated in clauses (ii)
and (iii) of this subparagraph respectively. The result of this calculation
is the hospital's Pass One projected payment amount from Pools One
and Two combined.
(v) Divide the Pass One projected payment amount from
Pool Two as calculated in clause (iii) of this subparagraph by the
hospital's Pass One projected payment amount from Pools One and Two
combined as calculated in clause (iv) of this subparagraph. The result
of this calculation is the percentage of the hospital's total Pass
One projected payment amount accruing from Pool Two.
(5) Pass Two - Redistribution of amounts in excess
of state payment caps from Pass One for Pools One and Two combined.
In the event that the projected payment amount calculated in paragraph
(4)(B)(iv) of this subsection plus any previous payment amounts for
the program year exceeds a hospital's state payment cap, the payment
amount will be reduced such that the sum of the payment amount plus
any previous payment amounts is equal to the state payment cap. HHSC
will sum all resulting excess funds and redistribute that amount to
qualifying non-state-owned hospitals that have projected payments,
including any previous payment amounts for the program year, below
their state payment caps. For each such hospital, HHSC will:
(A) subtract the hospital's projected DSH payment from
paragraph (4)(B)(iv) of this subsection plus any previous payment
amounts for the program year from its state payment cap;
(B) sum the results of subparagraph (A) of this paragraph
for all hospitals; and
(C) compare the sum from subparagraph (B) of this paragraph
to the total excess funds calculated for all non-state-owned hospitals.
(i) If the sum of subparagraph (B) of this paragraph
is less than or equal to the total excess funds, HHSC will pay all
such hospitals up to their state payment cap.
(ii) If the sum of subparagraph (B) of this paragraph
is greater than the total excess funds, HHSC will calculate payments
to all such hospitals as follows:
(I) Divide the result of subparagraph (A) of this paragraph
for each hospital by the sum from subparagraph (B) of this paragraph.
(II) Multiply the ratio from subclause (I) of this
clause by the sum of the excess funds from all non-state-owned hospitals.
(III) Add the result of subclause (II) of this clause
to the projected DSH payment for that hospital to calculate a revised
projected payment amount from Pools One and Two after Pass Two.
(D) If a governmental entity that operates or leases
to an Urban public hospital - Class two does not fully fund the amount
described in paragraph (2)(C)(iii)(I) of this subsection, HHSC will
reduce the hospital's Pass One and Pass Two DSH payment from Pool
Two to the level supported by the amount of the intergovernmental
transfer.
(E) If a governmental entity that operates or is under
a lease contract with a non-urban public hospital does not fully fund
the amount described in paragraph (2)(C)(iii)(II) of this subsection,
HHSC will reduce that portion of the hospital's Pass One and Pass
Two DSH payment from Pool Two to the level supported by the amount
of the intergovernmental transfer.
(F) If a governmental entity that owns and operates
an Urban public hospital - Class one does not fully fund the amount
described in paragraph (2)(C)(iii)(III) of this subsection, HHSC will
take the following steps:
(i) Provide an opportunity for the governmental entities
affiliated with the other Urban public hospitals - Class one to transfer
additional funds to HHSC;
(ii) Recalculate total DSH days for each Urban public
hospital - Class one for purposes of the calculations described in
paragraphs (4)(B) and (5)(A) - (C) of this subsection as follows:
(I) Divide the intergovernmental transfer made on behalf
of each Urban public hospital - Class one by the sum of intergovernmental
transfers made on behalf of all Urban public hospitals - Class one;
(II) Sum the total DSH days for all Urban public hospitals
- Class one, calculated as described in paragraph (4)(A) of this subsection;
and
(III) Multiply the result of subclause (I) of this
clause by the result of subclause (II) of this clause to determine
total DSH days for that hospital;
(iii) Recalculate Pass One payments from Pool Two and
Pass Two payments from Pools One and Two for Urban public hospitals
- Class one and private hospitals following the methodology described
in paragraphs (4)(B) and (5)(A) - (C) of this subsection substituting
the results from clause (ii) of this subparagraph for the results
from paragraph (4)(A) of this subsection for Urban public hospitals
- Class one;
(iv) Perform a second recalculation of Pass Two payments
from Pools One and Two for Urban public hospitals - Class one as follows:
Cont'd... |
