| (a) Introduction. Beginning October 1, 2019, Texas
Healthcare Transformation and Quality Improvement 1115 Waiver payments
are available under this section for eligible governmental ambulance
providers to help defray the uncompensated cost of charity care. Waiver
payments to governmental ambulance providers for uncompensated care
provided before October 1, 2019, are described in §355.8600 of
this subchapter (relating to Reimbursement Methodology for Ambulance
Services).
(b) Definitions.
(1) Centers for Medicare & Medicaid Services (CMS)--The
federal agency within the United States Department of Health and Human
Services responsible for overseeing and directing Medicare and Medicaid,
or its successor.
(2) Certified public expenditure (CPE)--An expenditure
certified by a governmental entity to represent its contribution of
public funds in providing services that are eligible for federal matching
Medicaid funds.
(3) Charity care--Healthcare services provided without
expectation of reimbursement to uninsured patients who meet the provider's
charity-care policy. The charity-care policy should adhere to the
charity-care principles of the Healthcare Financial Management Association
Principles and Practices Board Statement 15 (December 2012). Charity
care includes full or partial discounts given to uninsured patients
who meet the provider's financial assistance policy. Charity care
does not include bad debt, courtesy allowances, or discounts given
to patients who do not meet the provider's charity-care policy or
financial assistance policy.
(4) Demonstration year--The 12-month period beginning
October 1 for which the payments calculated under this section are
made. Demonstration year one was October 1, 2011, through September
30, 2012.
(5) Governmental entity--A state agency or a political
subdivision of the state. A governmental entity includes a hospital
authority, hospital district, city, county, or state entity.
(6) HHSC--The Texas Health and Human Services Commission
or its designee.
(7) Public funds--Funds derived from taxes, assessments,
levies, investments, and other public revenues within the sole and
unrestricted control of a governmental entity. Public funds do not
include gifts, grants, trusts, or donations, the use of which is conditioned
on supplying a benefit solely to the donor or grantor of the funds.
(8) Governmental ambulance provider--An ambulance provider
that uses paid government employees to provide ambulance services.
The ambulance services must be directly funded by a governmental entity.
A private ambulance provider under contract with a governmental entity
to provide ambulance services is not considered a governmental ambulance
provider for the purposes of this section.
(9) Uncompensated-care application--A form prescribed
by HHSC to identify uncompensated costs for Medicaid-enrolled providers.
(10) Uncompensated-care payments--Payments intended
to defray the uncompensated costs of charity care as defined in paragraph
(3) of this subsection.
(11) Uninsured patient--An individual who has no health
insurance or other source of third-party coverage for the services
provided. The term includes an individual enrolled in Medicaid who
received services that do not meet the definition of medical assistance
in section 1905(a) of the Social Security Act (Medicaid services),
if such inclusion is specified in the hospital's charity-care policy
or financial assistance policy and the patient meets the hospital's
policy criteria.
(12) Waiver--The Texas Healthcare Transformation and
Quality Improvement Program Medicaid demonstration waiver under §1115
of the Social Security Act.
(c) Eligibility.
(1) A governmental ambulance provider must submit a
written request for eligibility for supplemental payment in a form
prescribed by HHSC to the HHSC Provider Finance Department by a date
specified each year by HHSC. An acceptable request must include:
(A) an overview of the governmental agency;
(B) a complete organizational chart of the governmental
agency;
(C) a complete organizational chart of the ambulance
department within the governmental agency providing ambulance services;
(D) an identification of the specific geographic service
area covered by the ambulance department, by ZIP code;
(E) copies of all job descriptions for staff types
or job categories of staff who work for the ambulance department and
an estimated percentage of time spent working for the ambulance department
and for other departments of the governmental agency;
(F) a primary contact person for the governmental agency
who can respond to questions about the ambulance department; and
(G) a signed letter documenting the governmental ambulance
provider's voluntary contribution of non-federal funds.
(2) If eligible, a governmental ambulance provider
may begin to claim uncompensated-care costs related to services provided
on or after the first day of the month after the request for eligibility
is approved.
(d) Source of funding. The non-federal share of funding
for payments under this section is limited to public funds from governmental
entities. Prior to processing uncompensated-care payments for any
payment period within a waiver demonstration year, HHSC will survey
the governmental entities that provide public funds for the governmental
ambulance providers in the pool to determine the amount of funding
available to support payments from that pool.
(e) Payment frequency. HHSC will distribute uncompensated-care
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 amount of funds allocated to the provider's uncompensated-care
pool for the demonstration year as described in §355.8212 of
this division (relating to Waiver Payments to Hospitals for Uncompensated
Charity Care). If payments for uncompensated care for the governmental
ambulance provider pool attributable to a demonstration year are expected
to exceed the 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)(3) of this section.
(2) Payments made under this section are limited by
the availability of funds identified in subsection (d) of this section.
If sufficient funds are not available for all payments for which all
governmental ambulance providers are eligible, HHSC will reduce payments
as described in subsection (h)(2) of this section.
(g) Uncompensated-care payment amount.
(1) Cost reports. Governmental ambulance providers
that are eligible for supplemental payments must submit an annual
cost report for ground, water, and air ambulance services delivered
to individuals who meet the provider's charity-care policy.
(A) The cost report form will be specified by HHSC.
Providers certify through the cost report process their total actual
federal and non-federal costs and expenditures for the cost reporting
period.
(B) Cost reports must be completed for the full demonstration
year for which payments are being calculated. HHSC may require a newly
eligible provider to submit a partial-year cost report for their first
year of eligibility. The beginning date for the partial-year cost
report is the provider's first day of eligibility for supplemental
payments as determined by HHSC. The ending date of the partial-year
cost report is the last day of the demonstration year that encompasses
the cost report beginning date.
(C) The cost report is due on or before March 31 of
the year following the cost reporting period ending date and must
be certified in a manner specified by HHSC.
(i) If March 31 falls on a federal or state holiday
or weekend, the due date is the first working day after March 31.
(ii) A provider may request in writing an extension
of up to 30 days after the due date to submit a cost report. HHSC
will respond to all written requests for extensions, indicating whether
the extension is granted. HHSC must receive a request for extension
before the cost report due date. A request for extension received
after the due date is considered denied.
(iii) A provider whose cost report is not received
by the due date or the HHSC-approved extended due date is ineligible
for supplemental payments for the federal fiscal year.
(iv) The individual who completes the cost report on
behalf of the provider ("the preparer") must complete the state-sponsored
cost report training every other year for the odd-year cost report
in order to receive credit to complete both that odd-year cost report
and the following even-year cost report. If a new preparer wishes
to complete an even-year cost report and has not completed the previous
odd-year cost report training, to receive training credit to complete
the even-year cost report, the preparer must complete an even-year
cost Cont'd... |
