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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355REIMBURSEMENT RATES
SUBCHAPTER JPURCHASED HEALTH SERVICES
DIVISION 4MEDICAID HOSPITAL SERVICES
RULE §355.8068Local Provider Participation Fund Reporting

(a) Purpose. As required by federal and state law, the Health and Human Services Commission (HHSC) requires a local jurisdiction that operates a local provider participation fund (LPPF) to report mandatory payments.

(b) Definitions.

  (1) Institutional health care provider--A non-public hospital that provides inpatient hospital services.

  (2) Local jurisdiction--A non-state governmental entity that operates an LPPF.

  (3) Mandatory payment--A payment required to be made to an LPPF based on the net patient revenue of a paying hospital.

  (4) Paying hospital--An institutional health care provider required to make a mandatory payment.

  (5) Rate--The amount calculated for each paying hospital to submit to the LPPF.

(c) A local jurisdiction that operates an LPPF must report information to HHSC in a form and format to be determined by HHSC as described in subsection (e) of this section.

(d) The information must be reported for each federal fiscal quarter, no later than ten calendar days after the end of the federal fiscal quarter. HHSC will open the information reporting system prior to the end of the federal fiscal quarter.

(e) The report for each federal fiscal quarter must include:

  (1) the rate used to determine the mandatory payment;

  (2) a list of all paying hospitals;

  (3) the amount of the mandatory payment required of each paying hospital;

  (4) the amount of the mandatory payment received by the LPPF from each paying hospital;

  (5) the sum of the mandatory payments received by the LPPF; and

  (6) the purpose for which the LPPF funds were expended or transferred and the amount and date for each transfer or expenditure.

(f) If a local jurisdiction that created an LPPF fails to submit the required information, HHSC will not accept a transfer of LPPF funds for any Medicaid program from the local jurisdiction until the reporting requirement is satisfied.


Source Note: The provisions of this §355.8068 adopted to be effective November 1, 2019, 44 TexReg 6025

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