(ii)a percentage of the total estimated ACR UPL, not
to exceed 90 percent, on a per class basis less what Medicaid paid
for the services and any payments received under UHRIP, including
hospitals that are not participating in ACIA and less any payments
received under ACIA.
(B)Allocation of funds across hospitals will be calculated
by allocating to each hospital the sum of:
(i)the difference in the amount the hospital is estimated
to be paid under paragraph (2)(A) of this subsection and the amount
they would be paid if the percentage described in paragraph (2)(A)
of this subsection were the same percentage cited in subparagraph
(A)(i) of this paragraph; and
(ii)the difference in the amount the hospital is estimated
to be paid under paragraph (3)(C) of this subsection and the amount
they would be paid if the percentage described in paragraph (3)(B)
of this subsection were the same percentage cited in subparagraph
(A)(ii) of this paragraph.
(h)Distribution of CHIRP payments. [CHIRP payments
will be based upon actual utilization and will be paid as a percentage
increase above the contracted rate between the MCO and the hospital.]
(1)CHIRP payments for UHRIP and ACIA
components will be based upon actual utilization and will be paid
as a percentage increase above the contracted rate between the MCO
and the hospital. The determination of percentage of rate increase
will be as follows.
(A)HHSC will determine the percentage of rate increase
applicable to one or more classes of hospital by program component.
(B)UHRIP rate increases will be determined by HHSC
to be the percentage that is estimated to result in payments for the
class that are equivalent to the amount described under subsection
(g)(2)(A) of this section.
(C)ACIA will be determined by HHSC to be a percentage
that is estimated to result in payments for the hospital that are
equivalent to the amount described under subsection (g)(3)(D) of this
section.
(2)For program periods beginning
on or after September 1, 2024, CHIRP payments for the APHRIQA component
will be based on achievement of performance measures established in
accordance with §353.1307 of this subchapter.
(A)MCOs will be directed by HHSC to pay hospitals
on a monthly, quarterly, semi-annual, or annual basis that aligns
with the applicable performance achievement measurement period under
§353.1307 of this subchapter.
(B)MCOs will be required to distribute payments to
providers within 20 business days of notification by HHSC of provider
achievement results.
(C)Funds that are not earned by a provider due to
failure to achieve performance requirements will be redistributed
to other hospitals in the same hospital SDA and class based on each
hospital's proportion of total earned APHRIQA funds in the SDA. If
no other hospital in the SDA and class receives performance payments,
unearned funds will be redistributed to all hospitals in the SDA based
on each hospital's proportion of total earned APHRIQA funds and projected
to be paid to the hospitals through UHRIP and ACIA.
(3)HHSC will limit the amounts paid
to providers determined pursuant to this subsection to no more than
the levels that are supported by the amount described in subsection
(i)(3) of this section. Nothing in this section may be construed to
limit the authority of the state to require the sponsoring governmental
entities to transfer additional funds to HHSC following the reconciliation
process described in §353.1301(g) of this subchapter, if the
amount previously transferred is less than the non-federal share of
the amount expended by HHSC in the SDA for this program.
(4)After determining the percentage
of rate increase using the process described in paragraph (1) of this
subsection, HHSC will modify its contracts with the MCOs in the SDA
to direct the percentage rate increases.
[(i)Determination of percentage of
rate increase.]
[(1)HHSC will determine the percentage of rate increase
applicable to one or more classes of hospital by program component.]
[(A)UHRIP rate increases will be determined by HHSC
to be the percentage that is estimated to result in payments for the
class that are equivalent to the amount described under subsection
(g)(2)(A) of this section.]
[(B)ACIA will be determined by HHSC to be a percentage
that is estimated to result in payments for the hospital that are
equivalent to the amount described under subsection (g)(3)(A) of this
section.]
[(2)HHSC will limit the percentage rate increases
determined pursuant to this subsection to no more than the levels
that are supported by the amount described in subsection (j)(3) of
this section. Nothing in this section may be construed to limit the
authority of the state to require the sponsoring governmental entities
to transfer additional funds to HHSC following the reconciliation
process described in §353.1301(g) of this subchapter, if the
amount previously transferred is less than the non-federal share of
the amount expended by HHSC in the SDA for this program.]
[(3)After determining the percentage of rate increase
using the process described in paragraphs (1) and (2) of this subsection,
HHSC will modify its contracts with the MCOs in the SDA to direct
the percentage rate increases.]
(i)[(j)] Non-federal share of
CHIRP payments. The non-federal share of all CHIRP payments is funded
through IGTs from sponsoring governmental entities. No state general
revenue is available to support CHIRP.
(1)HHSC will communicate suggested IGT responsibilities
for the program period with all CHIRP hospitals at least 10 calendar
days prior to the IGT declaration of intent deadline. Suggested IGT
responsibilities will be based on the maximum dollars to be available
under the CHIRP program for the program period as determined by HHSC,
plus eight percent; and forecast member months for the program period
as determined by HHSC. HHSC will also communicate estimated revenues
each enrolled hospital could earn under CHIRP for the program period
with those estimates based on HHSC's suggested IGT responsibilities
and an assumption that all enrolled hospitals will meet 100 percent
of their quality metrics and maintain consistent utilization with
the prior year.
(2)Sponsoring governmental entities will determine
the amount of IGT they intend to transfer to HHSC for the entire program
period and provide a declaration of intent to HHSC no later than 21
business days before the first half of the IGT amount is transferred
to HHSC.
(A)The declaration of intent is a form prescribed
by HHSC that includes the total amount of IGT the sponsoring governmental
entity intends to transfer to HHSC.
(B)The declaration of intent is certified to the best
knowledge and belief of a person legally authorized to sign for the
sponsoring governmental entity but does not bind the sponsoring governmental
entity to transfer IGT.
(3)HHSC will issue an IGT notification to specify
the date that IGT is requested to be transferred no fewer than 14
business days before IGT transfers are due. Sponsoring governmental
entities will transfer the first half of the IGT amount by a date
determined by HHSC, but no later than June 1. Sponsoring governmental
entities will transfer the second half of the IGT amount by a date
determined by HHSC, but no later than December 1. HHSC will publish
the IGT deadlines and all associated dates on its Internet website
no later than March 15 of each year.
(j)[(k)] Effective date of rate
increases. HHSC will direct MCOs to increase rates under this section
beginning the first day of the program period that includes the increased
capitation rates paid by HHSC to each MCO pursuant to the contract
between them.
(k)[(l)] Changes in operation.
If an enrolled hospital closes voluntarily or ceases to provide hospital
services in its facility, the hospital must notify the HHSC Provider
Finance Department by hand delivery, United States (U.S.) mail, or
special mail delivery within 10 business days of closing or ceasing
to provide hospital services. Notification is considered to have occurred
when the HHSC Provider Finance Department receives the notice.
(l)Data correction request. Any provider-requested
data or calculation correction must be submitted prior to the date
on which the first half of the IGT amount is due under subsection
(i)(3) of this section.
(m)Reconciliation. HHSC will reconcile the amount
of the non-federal funds actually expended under this section during
the program period with the amount of funds transferred to HHSC by
the sponsoring governmental entities for that same period using the
methodology described in §353.1301(g) of this subchapter.
(n)Recoupment. Payments under this section may be
subject to recoupment as described in §353.1301(j) and §353.1301(k)
of this subchapter.
The agency certifies that legal counsel has
reviewed the proposal and found it to be within the state agency's
legal authority to adopt.
Filed with the Office
of the Secretary of State on November 6, 2023
TRD-202304077 Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: December 17, 2023
For further information, please call: (512) 487-3480
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