| (A) HHSC must receive the non-federal portion of reimbursement
for HARP through a method approved by HHSC and CMS for reimbursement
through this program.
(B) A hospital under this subsection must designate
a single local governmental entity to provide the non-federal share
of the payment through a method determined by HHSC. If the single
local governmental entity transfers less than the full non-federal
share of a hospital's payment amount calculated in any paragraph under
this subchapter, HHSC will recalculate that specific hospital's payment
based on the amount of the non-federal share actually transferred.
(C) HHSC will communicate suggested IGT responsibilities.
Suggested IGT responsibilities will be based on the maximum dollars
to be available under the program for the program period as determined
by HHSC. HHSC will also communicate estimated revenues each enrolled
hospital could earn under the program for the program period with
those estimates based on HHSC's suggested IGT responsibilities.
(D) HHSC will issue an IGT notification to specify
the date that IGT is requested to be transferred not fewer than 14
business days before IGT transfers are due. HHSC will publish the
IGT deadlines and all associated dates on its Internet website.
(3) Payment Methodology.
(A) To determine payment under this section for each
participating state-owned hospital reimbursed through Prospective
Payment System (PPS), HHSC will sum the hospital's inpatient FFS Medicare
payment gap and the hospital's outpatient FFS Medicare payment gap.
(B) To determine payment under this section for each
participating state-owned hospital not reimbursed through Prospective
Payment System (PPS), HHSC will use the hospital's FFS outpatient
Medicare payment gap.
(g) Payments for state government-owned IMDs.
(1) Eligible hospitals.
(A) Payments under this subsection will be limited
to hospitals defined as "state government-owned IMD" in subsection
(b) of this section that are enrolled in Medicare and participate
in Texas Medicaid fee-for-service.
(B) The hospital must have submitted at least one adjudicated
FFS Medicaid claim for each reporting period to be eligible for payment.
(2) Non-federal share of program payments. The non-federal
share of the payments is funded through IGTs from sponsoring governmental
entities. No state general revenue is available to support the program.
(A) HHSC must receive the non-federal portion of reimbursement
for HARP through a method approved by HHSC and CMS for reimbursement
through this program.
(B) A hospital under this subsection must designate
a single local governmental entity to provide the non-federal share
of the payment through a method determined by HHSC. If the single
local governmental entity transfers less than the full non-federal
share of a hospital's payment amount calculated in any paragraph under
this subchapter, HHSC will recalculate that specific hospital's payment
based on the amount of the non-federal share actually transferred.
(C) HHSC will communicate suggested IGT responsibilities.
Suggested IGT responsibilities will be based on the maximum dollars
to be available under the program for the program period as determined
by HHSC. HHSC will also communicate estimated revenues each enrolled
hospital could earn under the program for the program period with
those estimates based on HHSC's suggested IGT responsibilities.
(D) HHSC will issue an IGT notification to specify
the date that IGT is requested to be transferred not fewer than 14
business days before IGT transfers are due. HHSC may post the IGT
deadlines and other associated information on HHSC's website, send
the information through the established Medicaid notification procedures
used by HHSC's fiscal intermediary, send through other direct mailing,
send through GovDelivery, or provide the information to the hospital
associations to disseminate to their member hospitals.
(3) Payment Methodology. To determine each participating
state government-owned IMD hospital's payment under this section,
HHSC will use the hospital's inpatient FFS Medicare payment gap.
(h) Payments for private IMDs.
(1) Eligible hospitals.
(A) Payments under this subsection will be limited
to hospitals defined as "private IMD" in subsection (b) of this section
that participate in Texas Medicaid fee-for-service.
(B) The hospital must have submitted at least one adjudicated
FFS Medicaid claim for each reporting period to be eligible for payment.
(2) Non-federal share of program payments. The non-federal
share of the payments is funded through IGTs from sponsoring governmental
entities. No state general revenue is available to support the program.
(A) HHSC must receive the non-federal portion of reimbursement
for HARP through a method approved by HHSC and CMS for reimbursement
through this program.
(B) A hospital under this subsection must designate
a single local governmental entity to provide the non-federal share
of the payment through a method determined by HHSC. If the single
local governmental entity transfers less than the full non-federal
share of a hospital's payment amount calculated in any paragraph under
this subchapter, HHSC will recalculate that specific hospital's payment
based on the amount of the non-federal share actually transferred.
(C) HHSC will communicate suggested IGT responsibilities.
Suggested IGT responsibilities will be based on the maximum dollars
to be available under the program for the program period as determined
by HHSC. HHSC will also communicate estimated revenues each enrolled
hospital could earn under the program for the program period with
those estimates based on HHSC's suggested IGT responsibilities.
(D) HHSC will issue an IGT notification to specify
the date that IGT is requested to be transferred not fewer than 14
business days before IGT transfers are due. HHSC may post the IGT
deadlines and other associated information on HHSC's website, send
the information through the established Medicaid notification procedures
used by HHSC's fiscal intermediary, send through other direct mailing,
send through GovDelivery, or provide the information to the hospital
associations to disseminate to their member hospitals.
(3) Payment Methodology. To determine each participating
private IMD hospital's payment under this section, HHSC will use the
hospital's inpatient FFS Medicare payment gap.
(i) Changes in operation. If an enrolled hospital closes
voluntarily or ceases to provide hospital services in its facility,
the hospital must notify the HHSC Provider Finance Department by hand
delivery, United States (U.S.) mail, or special mail delivery within
10 business days of closing or ceasing to provide hospital services.
Notification is considered to have occurred when the HHSC Provider
Finance Department receives the notice.
(j) Reconciliation. HHSC will reconcile the amount
of the non-federal funds actually expended under this section during
the program period with the amount of funds transferred to HHSC by
the sponsoring governmental entities for that same period. If the
amount of non-federal funds actually expended under this section is
less than the amount transferred to HHSC, HHSC will refund the balance
proportionally to how it was received.
(k) Payments under this section will be made on a semi-annual
basis.
|
