| (B) A hospital must notify HHSC Provider Finance 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 public funds from governmental
entities. Governmental entities that choose to support payments under
this section affirm that funds transferred to HHSC meet federal requirements
related to the non-federal share of such payments, including §1903(w)
of the Social Security Act. Prior to processing uncompensated-care
payments for the final payment period within a waiver demonstration
year for any uncompensated-care pool or sub-pool described in subsection
(f)(2) of this section, HHSC will survey the governmental entities
that provide public funds for the hospitals in that pool or sub-pool
to determine the amount of funding available to support payments from
that pool or sub-pool.
(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)(6) of this section.
(2) HHSC will establish the following uncompensated-care
pools: for demonstration years nine and ten, a state-owned hospital
pool, a non-state-owned hospital pool, a physician group practice
pool, a governmental ambulance provider pool, and a publicly owned
dental provider pool. Beginning with demonstration year eleven and
after, the physician group practice pool will be further divided into
a state-owned physician group practice pool and a non-state-owned
physician group practice pool.
(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
the Texas Center for Infectious Disease.
(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) The state-owned physician group practice pool.
(i) Beginning in demonstration year eleven, the state-owned
physician group practice pool funds uncompensated-care payments to
state-owned physician groups, as defined in §355.8214 of this
division (relating to Waiver Payments to Physician Group Practices
for Uncompensated Charity Care).
(ii) HHSC will determine the allocation for this pool
at an amount less than or equal to the total maximum uncompensated-care
payment amount for these physicians.
(C) Non-state-owned provider pools. HHSC will allocate
the remaining available uncompensated-care funds, if any, 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) and the state-owned physician group practice
pool under subparagraph (B) of this paragraph. HHSC will allocate
the funds among non-state-owned provider pools based on the following
amounts.
(i) For the physician group practice pool in demonstration
years nine and ten, or the non-state-owned physician group practice
pool beginning in demonstration year eleven, the governmental ambulance
provider pool, and the publicly owned dental provider pool:
(I) for demonstration year nine, an amount to equal
the percentage of the applicable total uncompensated-care pool amount
paid to each group in demonstration year six; and
(II) for demonstration years ten and after, an amount
to equal a percentage determined by HHSC annually based on factors
including the amount of reported charity-care costs and the ratio
of reported charity-care costs to hospitals' charity-care costs. For
physicians, current year charity-care costs will be used, while for
dental and ambulance providers, prior year charity-care costs will
be used.
(ii) For the non-state-owned hospital pool, all of
the remaining funds after the allocations described in clause (i)
of this subparagraph. HHSC will further allocate the funds in the
non-state-owned hospital pool among all hospitals in the pool and
create non-state-owned hospital sub-pools as follows:
(I) calculate a revised maximum payment amount for
each non-state-owned hospital as described in subsection (g)(6) of
this section and allocate that amount to the hospital; and
(II) group all non-state-owned hospitals and non-state-owned
physician groups into sub-pools based on their geographic location
within one of the state's Medicaid service delivery areas (SDAs),
as described in subsection (g)(7) of this section.
(3) Payments made under this section are limited by
the availability of funds identified in subsection (d) of this section
and timely received by HHSC. If sufficient funds are not available
for all payments for which the providers in each pool or sub-pool
are eligible, HHSC will reduce payments as described in subsection
(h)(2) of this section.
(4) If for any reason funds allocated to a provider
pool or to individual providers within a sub-pool are not paid to
providers in that pool or sub-pool for the demonstration year, the
funds will be redistributed to other provider pools based on each
pool's pro-rata share of remaining uncompensated costs for the same
demonstration year. The redistribution will occur when the reconciliation
for that demonstration year is performed.
(g) Uncompensated-care payment amount.
(1) Application.
(A) Cost and payment data reported by a hospital in
the uncompensated-care application is used to calculate the annual
maximum uncompensated-care payment amount for the applicable demonstration
year, as described in paragraph (2) of this subsection.
(B) Unless otherwise instructed in the application,
a hospital must base the cost and payment data reported in the application
on its applicable as-filed CMS 2552 Cost Report(s) For Electronic
Filing Of Hospitals corresponding to the data year and must comply
with the application instructions or other guidance issued by HHSC.
(i) When the application requests data or information
outside of the as-filed cost report(s), a hospital must provide all
requested documentation to support the reported data or information.
(ii) For a new hospital, the cost and payment data
period may differ from the data year, resulting in the eligible uncompensated
costs based only on services provided after the hospital's Medicaid
enrollment date. HHSC will determine the data period in such situations.
(2) Calculation.
(A) A hospital's annual maximum uncompensated-care
payment amount is the sum of the components described in clauses (i)
- (iv) of this subparagraph.
(i) The hospital's inpatient and outpatient charity-care
costs pre-populated in or reported on the uncompensated-care application,
as described in paragraph (3) of this subsection, reduced by interim
DSH payments for the same program period, if any, that reimburse the
hospital for the same costs. To identify DSH payments that reimburse
the hospital for the same costs, HHSC will:
(I) use self-reported information on the application
to identify charges that can be claimed by the hospital in both DSH
and Uncompensated Care (UC), convert the charges to cost, and reduce
the cost by any applicable payments described in paragraph (3) of
this subsection;
(II) calculate a DSH-only uninsured shortfall by reducing
the hospital's total uninsured costs, calculated as described in §355.8066
of this subchapter, by the result from subclause (I) of this clause;
and
(III) reduce the interim DSH payment amount by the
sum of:
(-a-) the DSH-only uninsured shortfall calculated as
described in subclause (II) of this clause; and
(-b-) the hospital's Medicaid shortfall, calculated
as described in §355.8066 of this subchapter.
(ii) Other eligible costs for the data year, as described
in paragraph (4) of this subsection.
(iii) Cost and payment adjustments, if any, as described
in paragraph (5) of this subsection.
Cont'd... |
