Texas Register, Volume 38, Number 34, Pages 5371-5484, August 23, 2013 Page: 5,443
5371-5484 p. ; 28 cm.View a full description of this periodical.
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ment from the trauma facilities and emergency medical services ac-
count.
(8) Add-on status verification.
(A) Notification. HHSC will determine a hospital's ini-
tial add-on status by reference to the impact file and the Texas De-
partment of State Health Services' list of trauma-designated hospitals.
HHSC will notify the hospital of the CBSA to which the hospital is as-
signed, the Medicare education adjustment factor assigned to the hos-
pital for urban hospitals, the trauma level designation assigned to the
hospital, the Medicare teaching hospital designation for children's hos-
pitals, as applicable and any other related information determined rel-
evant by HHSC. HHSC may post the information on HHSC's website,
send the information through the established Medicaid notification pro-
cedures used by HHSC's fiscal intermediary, send through other direct
mailing, or provide the information to the hospital associations to dis-
seminate to their member hospitals.
(B) HHSC will calculate a hospital's final SDA using
the add-on status initially determined by HHSC unless, within 14 cal-
endar days after the date of the notification, HHSC receives notifica-
tion, in writing by regular mail, hand delivery or special mail delivery,
from the hospital (in a format determined by HHSC) that any add-on
status determined by HHSC is incorrect and:
(i) the hospital provides documentation of its eligi-
bility for a different trauma designation, medical education percentage,
or teaching hospital designation; or
(ii) the hospital provides documentation that it is ap-
proved by Medicare for reclassification to a different CBSA.
(C) If a hospital fails to notify HHSC within 14 calendar
days after the date of the notification that the add-on status as initially
determined by HHSC includes one or more add-ons for which the hos-
pital is not eligible, resulting in an overpayment, HHSC will recoup
such overpayment and will prospectively reduce the SDA accordingly.
(e) Final urban and children's hospital SDA calculations.
(1) HHSC calculates an urban hospital's final SDA as fol-
lows:
(A) Add all add-on amounts for which the hospital is
eligible to the base SDA.
(B) Multiply the SDA determined in subparagraph (A)
of this paragraph by the hospital's total relative weight of base year
claims as calculated in subsection (g)(1) of this section.
(C) Sum the amount calculated in subparagraph (B) of
this paragraph for all urban hospitals.
(D) Divide the total funds appropriated for reimbursing
inpatient urban hospital services under this section by the amount de-
termined in subparagraph (C) of this paragraph.
(E) Multiply the SDA determined for each hospital in
subparagraph (A) of this paragraph by the percentage determined in
subparagraph (D) of this paragraph.
(F) For new urban hospitals for which HHSC has no
base year claim data, the final SDA is the base SDA plus any add-ons
for which the hospital is eligible, multiplied by the percentage deter-
mined in subparagraph (D) of this paragraph.
(2) HHSC calculates a children's hospital's final SDA as
follows:
(A) Add all add-on amounts for which the hospital is
eligible to the base SDA.(B) For labor and delivery services provided to adults
age eighteen or greater in a children's hospital, the final SDA is equal
to the base SDA for urban hospitals without add-ons, calculated as de-
scribed in subsection (c)(3) of this section plus the urban hospital wage
add-on for an urban hospital located in the same CBSA as the children's
hospital providing the service.
(C) For new children's hospitals that are not teaching
hospitals for which HHSC has no base year claim data, the final SDA
is the base SDA plus the hospital's geographic wage add-on. The SDA
will be inflated from the base year to the current period at the time of
enrollment or to state fiscal year 2015, whichever is earlier.
(D) For new children's hospitals that qualify for the
teaching medical education add-on described in subsection (b)(31) of
this section for which HHSC has no base year claim data, the final
SDA is calculated based on one of the following options until rebasing
is performed with base year claim data for the hospital. A new chil-
dren's hospital must notify the HHSC Rate Analysis Department of its
selected option within 60 days from the date the hospital is notified
of its provider activation by HHSC's fiscal intermediary. If notice of
the option is not received, HHSC will assign the hospital the SDA
calculated as described in clause (i) of this subparagraph. The SDA
calculated based on the selected option will be effective retroactive to
the first day of the provider's enrollment.
(i) Children's hospital base SDA plus the applicable
geographic wage add-on and the minimum teaching add-on for exist-
ing children's hospitals. No settlement of costs is required for services
reimbursed under this option. The SDA will be in effective for the hos-
pital for three years or until the next rebasing when a new SDA will be
determined. The SDA will be inflated from the base year to the current
period at the time of enrollment or to state fiscal year 2015, whichever
is earlier.
(ii) Children's base SDA plus the applicable geo-
graphic wage add-on and the maximum teaching add-on for existing
children's hospitals. A cost settlement is required for services reim-
bursed under this option. The SDA will be in effect for the hospital
for three years or until the next rebasing when a new SDA will be
determined. The SDA will be inflated from the base year to the current
period at the time of enrollment or to state fiscal year 2015, whichever
is earlier.
(E) For state fiscal year 2014 only, HHSC will calculate
a blended SDA for children's hospitals, other than those described in
subparagraphs (C) and (D) of this paragraph, as follows:
(i) Calculate a full-cost SDA by dividing the hospi-
tal's total base year cost determined in subsection (c)(1)(A) of this sec-
tion by the number of claims in the base year;
(ii) Multiply the result of clause (i) of this subpara-
graph by 0.50;
(iii) Multiply the hospital's final base SDA from sub-
paragraph (A) of this paragraph by 0.50;
(iv) Sum the results of the calculations described in
clauses (ii) and (iii) of this subparagraph.
(v) The resulting blended SDA determined in clause
(iv) of this subparagraph will be adjusted by the inflation update factor
from the base year to state fiscal year 2014.
(F) For state fiscal year 2015, the final SDA determined
in subparagraphs (A), (C) and (D) of this paragraph will be adjusted by
the inflation update factor from the base year to state fiscal year 2015.
This SDA will remain in effect until the next rebasing.ADOPTED RULES August 23, 2013 38 TexReg 5443
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Texas. Secretary of State. Texas Register, Volume 38, Number 34, Pages 5371-5484, August 23, 2013, periodical, August 23, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth342079/m1/73/: accessed May 5, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.