| (C) Non-public hospitals must not return or reimburse
to a governmental entity any part of a payment under this section.
(D) Public Hospitals must be operated by a governmental
entity, have that designation filed with HHSC and must not receive,
and have no agreement to receive, any portion of the payments made
to any non-public hospital.
(E) A non-public provider must have paid the Uncompensated
Care (UC) application fee upon submission of the application in accordance
with §355.8200 of this subchapter.
(F) Beginning in demonstration year thirteen, all non-rural
hospitals, except for state-owned hospitals, will be required to enroll,
participate in, and comply with requirements for all voluntary supplemental
Medicaid or directed Medicaid programs for which the hospital is eligible,
including all components of those programs, within the State of Texas
to participate in UC. This requirement does not apply to a program
or component, as applicable, if:
(i) a hospital's estimated payment:
(I) is less than $25,000 from the entire program for
a program without multiple components; or
(II) is less than $25,000 from a component for a program
with multiple components; and
(ii) enrollment for the program concluded after the
effective date of this requirement.
(2) Uncompensated-care payments. For a hospital to
be eligible to receive uncompensated-care payments, in addition to
the requirements in paragraph (1) of this subsection, the hospital
must submit to HHSC an uncompensated-care application for the demonstration
year, as is more fully described in subsection (g)(1) of this section,
by the deadline specified by HHSC.
(3) Changes that may affect eligibility for uncompensated-care
payments.
(A) If a hospital closes, loses its license, loses
its Medicare or Medicaid eligibility, or files bankruptcy before receiving
all or a portion of the uncompensated-care payments for a demonstration
year, HHSC will determine the hospital's eligibility to receive payments
going forward on a case-by-case basis. In making the determination,
HHSC will consider multiple factors including whether the hospital
was in compliance with all requirements during the demonstration year
and whether it can satisfy the requirement to cooperate in the reconciliation
process as described in subsection (i) of this section.
(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, or Medicare or Medicaid enrollment
that may affect the hospital's continued eligibility for payments
under this section.
(C) Merged Hospitals.
(i) HHSC will consider a merger of two or more hospitals
for purposes of determining eligibility and calculating a hospital's
demonstration year payments under this section if:
(I) a hospital that was a party to the merger submits
to HHSC documents verifying the merger status with Medicare prior
to the deadline for submission of the UC application for that demonstration
year; and
(II) the hospital submitting the information under
subclause (I) assumed all Medicaid-related liabilities of each hospital
that is a party to the merger, as determined by HHSC after review
of the applicable agreements.
(ii) If the requirements of clause (i) are not met,
HHSC will not consider the merger for purposes of determining eligibility
or calculating a hospital's demonstration year payments under this
section. Until HHSC determines that the hospitals are eligible for
payments as a merged hospital, each of the merging hospitals will
continue to receive any UC payments to which they were entitled prior
to the merger.
(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) Maximum aggregate amount of provider pool funds.
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) Uncompensated-care pools.
(A) HHSC will designate different pools for demonstration
years as follows:
(i) 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;
(ii) for demonstration year eleven, a state-owned hospital
pool, a non-state-owned hospital pool, a state-owned physician group
practice pool, a governmental ambulance provider pool, and a publicly
owned dental provider pool; and
(iii) for demonstration years twelve and beyond, a
state-owned hospital pool, a non-state-owned hospital pool, a high
impecunious charge hospital (HICH) pool, a state-owned physician group
practice pool, a non-state-owned physician group practice pool, a
governmental ambulance provider pool, and a publicly owned dental
provider pool.
(B) The state-owned hospital pool.
(i) The state-owned hospital pool funds uncompensated-care
payments to state-owned hospitals as defined in subsection (b) of
this section.
(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.
(C) 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.
(D) The High Impecunious Charge Hospital (HICH) pool.
(i) Beginning in demonstration year twelve, the HICH
pool funds will be allocated amongst hospitals with a high proportion
of uncompensated care charges, rural, and state-owned hospitals. While
the funds are set aside before the non-state provider pools, the payments
will be calculated for each hospital after both the state-owned hospital
pool payments in subparagraph (B) of this paragraph and non-state-owned
hospital pool payments in subparagraph (E) of this paragraph.
(ii) A hospital will be deemed as having a high proportion
of uncompensated care charges if its impecunious charge ratio is equal
to or greater than 27.5 percent, calculated as follows:
(I) The sum of the charges for DSH uninsured charges
and total uninsured charity charges, minus any duplicate uninsured
charges is the numerator.
(II) The total allowable hospital revenue is the denominator.
(iii) HHSC will determine the allocation for this pool
at an amount less than the difference in the amount of the total allowable
UC pool and the amount of the total allowable UC pool in DY11 but
equal to a percentage determined by HHSC annually based on certain
factors including charity-care costs, the ratio of reported charity-care
costs to hospitals' charity-care costs, and the overall financial
stability of hospitals of all ownership types and geographic locations
as determined by HHSC.
(E) 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 pools under subparagraphs
(B) - (D) of this paragraph. HHSC will allocate the funds among non-state-owned
provider pools based on Cont'd... |
