| report training. No exemptions from the cost report training
requirements will be granted.
(D) A cost report documents the provider's actual allowable
charity-care costs for delivering ambulance services in accordance
with the applicable state and federal regulations. Because the cost
report is used to determine supplemental payments, a provider must
submit a complete and acceptable cost report to be eligible for a
supplemental payment.
(E) The uncompensated-care payment is contingent upon
the governmental ambulance provider's CPEs related to charity-care
services. There are two CPE forms that must be submitted with each
cost report:
(i) The cost report certification form formally acknowledges
that the cost report is true, correct, and complete, and was prepared
in accordance to all applicable rules and regulations.
(ii) The certification of funds form acknowledges that
the claimed expenditures are allocable and allowable to the State
Medicaid program under Title XIX of the Social Security Act, and in
accordance with all procedures, instructions, and guidance issued
by the single state agency and in effect during the cost report federal
fiscal year.
(2) Calculation. An ambulance provider's annual maximum
uncompensated-care payment amount is calculated as follows:
(A) As detailed in the cost report instructions, a
provider must report their charges associated with charity-care services
provided to uninsured patients and any payments attributable to those
services.
(B) A provider's total allowable reported costs for
ambulance services are allocated to uninsured charity-care patients
based on the ratio of charges for uninsured charity-care patients
to the charges for all patients. Only allocable expenditures related
to uninsured charity care as defined in subsection (b)(3) of this
section will be included in calculating the uncompensated-care payment.
(C) The result of subparagraph (B) of this paragraph
will be reduced by any related payments reported on the cost report
to determine the provider's annual maximum uncompensated-care payment
amount.
(3) Reduction to stay within the governmental ambulance
provider uncompensated-care pool allocation amount. Prior to processing
uncompensated-care payments for any payment period within a waiver
demonstration year, HHSC will determine if such a payment would cause
total uncompensated-care payments for the demonstration year for the
governmental ambulance provider pool to exceed the allocation amount
for the pool and will reduce the maximum uncompensated-care payment
amounts for each provider in the pool by the same percentage as required
to remain within the pool allocation amount.
(h) Recoupment.
(1) In the event of an overpayment identified by HHSC
or a disallowance by CMS of federal financial participation related
to a provider's receipt or use of payments under this section, HHSC
may recoup an amount equivalent to the amount of the federal share
of the overpayment or disallowance.
(2) Payments under this section may be subject to adjustment
for payments made in error, including, without limitation, adjustments
under §371.1711 of this title (relating to Recoupment of Overpayments
and Debts), 42 CFR Part 455, and Chapter 403 of the Texas Government
Code. HHSC may recoup an amount equivalent to any such adjustment.
(3) HHSC may recoup from any current or future Medicaid
payments as follows:
(A) HHSC will recoup from the provider against which
any overpayment was made or disallowance was directed.
(B) If, within 30 days of the provider's receipt of
HHSC's written notice of recoupment, the provider has not paid the
full amount of the recoupment or entered into a written agreement
with HHSC to do so, HHSC may withhold any or all future Medicaid payments
from the provider until HHSC has recovered an amount equal to the
amount overpaid or disallowed.
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