Texas Register, Volume 38, Number 26, Pages 4053-4242, June 28, 2013 Page: 4,108
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Children's Hospital Reimbursement Methodology will eliminate
TEFRA-related language referenced in the rule.
- Section 355.8052 is amended to describe a new SDA method-
ology for reimbursing children's hospitals using a statewide
base SDA with add-ons for geographic wage differences and for
teaching medical education; and for reimbursing rural hospitals
using a facility-specific SDA limited by a floor and a ceiling.
Language was added to describe how new children's and rural
facilities will be reimbursed under this new SDA methodology,
and the phase down of hospitals located in Rockwall County
from rural to urban hospitals.
- Section 355.8052 is also amended to reimburse for labor and
delivery services provided to adults at children's hospitals at the
same rates used for urban hospitals without add-on rates.
- Section 355.8052 is also amended to reduce all outlier pay-
ments by 10 percent except for outlier payments made to chil-
dren's hospitals.
- Section 355.8052 adds a revised definition of rural hospitals.
- Section 355.8052 is also amended to revise the formula for the
determination of the payment of a day outlier or a cost outlier.
This revision is intended to ensure that the payment for a day out-
lier will not exceed the amount of the calculated cost outlier. The
proposed rule changes also include other technical corrections,
numbering revisions and non-substantive changes to make the
rule more readable and understandable.
Section-by-Section Summary
355.8052 Inpatient Hospital Reimbursement
Removing the previous language from subsection (a) pertain-
ing to the application and general reimbursement method and
adding an introduction that is consistent with other reimburse-
ment rules.
Removing obsolete language relating to exceptions from sub-
section (b).
Adding to subsection (b)(5)(E) state owned teaching hospitals
and freestanding psychiatric hospitals as excluded claim types
for base year claims.
Removing from subsection (b)(6) the obsolete reference to the
TEFRA target cap.
Adding to subsection (b)(7) the definition of a children's hospital.
Removing from subsection (b)(13) the reference to children's
hospitals.
Adding to subsection (b)(1 8) a definition of inflation update factor.
Removing previous subsection (b)(18), interim payment, as it is
obsolete.
Removing from subsection (b)(20) an obsolete reference to
TEFRA.
Adding to subsection (b)(27) the definition of a rural hospital.
Removing previous subsection (b)(26) to remove references to
state owned teaching hospitals that are not needed.
Removing previous subsection (b)(28) as TEFRA target cap is
no longer applicable.
Adding to subsection (b)(29) the definition of a teaching medical
education add-on.
Adding to subsection (b)(35) the definition of an urban hospital.Revising subsection (c) to provide clarification of a separate
statewide base SDA for children's hospitals and for urban
hospitals.
Revising subsection (c)(1)(A) to clarify that the sum of the base
year costs is used to calculate the universal mean.
Revising subsection (c)(1)(B) to clarify that hospitals' base year
costs are derived from subparagraph (A).
Revising subsection (c)(1)(C) to provide the method for the chil-
dren's hospital base SDA calculation.
Adding new subsection (c)(1)(D) to provide the methods by
which the universal mean is derived for urban hospitals and for
children's hospitals.
Revising subsection (c)(2) to add the references for urban hos-
pitals and children's hospitals.
Removing an obsolete reference from subsection (c)(2)(A).
Adding new subsection (d)(1) to specify the conditions in which
children's hospitals may receive increases to the base SDA
through add-on rates.
Revising subsection (d)(2) to clarify that this subsection applies
to urban hospitals.
Revising subsection (d)(3) to provide clarification that the geo-
graphic wage add-on is reclassified under Medicare. It also adds
teaching medical education as an add-on and provides guidance
for the applicability of the add-on for children's hospitals that are
new to the Medicaid program and do not have a cost report avail-
able.
Revising subsection (d)(4)(A) to add children's hospitals as eli-
gible for a geographic wage add-on.
Adding new subsection (d)(5) to describe eligibility and calcula-
tion for a teaching medical education add-on for children's hos-
pitals.
Adding to subsection (d)(6)(A) to clarify that the medical educa-
tion add-on is for urban hospitals.
Revising subsection (d)(8)(A) to add Medicare teaching hospital
designation for children's hospitals as part of the HHSC notifica-
tion.
Revising subsection (d)(8)(B)(i) to require hospitals to provide
documentation of eligibility for a different teaching hospital des-
ignation.
Revising subsection (e) to clarify that the final SDA calculation
in this section applies to both urban and children's hospitals.
Revising subsection (e)(1)(B) to clarify that the base year claims
are calculated in subsection (g)(1) of this section.
Revising subsection (e)(1)(C) to clarify that this subparagraph
applies to urban hospitals.
Revising subsection (e)(1)(D) to clarify that this subparagraph
applies to urban hospitals.
Adding new subsection (e)(2) to provide the methodology by
which a children's hospitals final SDA is calculated.
Moving the methodology for new urban hospitals with no base
year claim data from previous (f)(3) to (e)(1)(F).
Moving previous subsection (e)(5), pertaining to adjustments, to
subsection (k).38 TexReg 4108 June 28, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 26, Pages 4053-4242, June 28, 2013, periodical, June 28, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth313178/m1/56/: accessed April 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.